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L. H. Suh, W. W. Culbertson; Use of Anterior Chamber Optical Coherence Tomography (AC-OCT) Imaging in Descemet’s Stripping With Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3871.
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To use anterior chamber optical coherence tomography (AC-OCT) for the preoperative and postoperative imaging of corneas undergoing Descemet’s Stripping with Endothelial Keratoplasty (DSEK). In DSEK, a donor corneoscleral button is precut in a lamellar fashion with a microkeratome to create a donor posterior lamellar button containing posterior stroma and endothelium. During DSEK, Descemet’s membrane and endothelium are stripped and replaced with the donor lamellar button. The AC-OCT was used to assess the preoperative cornea, the state of the DSEK button postoperatively, and to assess for any postoperative complications such as detachments and interface abnormalities.
The Visante OCT (Carl Zeiss Meditec, Dublin, CA) was used in patients undergoing DSEK. A donor corneoscleral button mounted in an artificial anterior chamber (Moria, Doylestown, PA) with a lamellar plane created by a microkeratome was imaged. Before surgery, the recipient cornea in one patient was imaged to assess preoperative corneal thickness. AC-OCT was also used to assess postoperative states and complications such as graft detachments and interface haze.
In one patient with pseudophakic bullous keratopathy, the AC-OCT showed thickening of the stroma and epithelial bullae. The AC-OCT imaged the lamellar plane created by a microkeratome in a donor corneoscleral button mounted on an anterior chamber. The AC-OCT also showed the normal apposition of the DSEK lamellar button to the recipient stroma. The lamellar button was meniscus-shaped with tapered flanges. Progressive deturgescence of a cornea after uncomplicated DSEK was also imaged. Finally, postoperative complications such as donor button detachment and the presence of fluid, epithelial ingrowth, blood, and Descemet’s membrane in the recipient-donor interface was assessed with AC-OCT.
There are many applications of AC-OCT in DSEK surgery. The preoperative thickness can be gauged by the AC-OCT and compared to postoperative thicknesses. The plane created by the microkeratome in the donor button preparation can be shown by AC-OCT. Progressive deturgescence of the recipient cornea can be followed. Finally, complications of DSEK surgery, such as detachment and presence of interface material can be easily imaged with AC-OCT.
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