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Young-Sik Yoo, Sucbei Moon, Sung-Hyun Choi, Sung-Won Shin, Woong-Gyu Jung, Choun-Ki Joo; Big-bubble technique with depth-sensing needle for precision lamellar keratoplasty. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5663.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose was to evaluate the effectiveness of a depth-sensing needle system for big-bubble technique in deep anterior lamellar keratoplasty (DALK) or pre-descemet's endothelial keratoplasty (PDEK).
In this experimental study, the big-bubble technique for DALK was performed with the depth-sensing needle system. Human cornea was used in this ex-vivo study. The depth-sensing needle system was composed of the fiber optic based needle and optical coherent tomography (OCT) system which was developed for sensing the depth between the needle and the endothelial layer of cornea. The needle is aimed to be located at 80–90% of total corneal thickness (about 50–100 µm above the corneal endothelial layer). The real-time position information of the needle tip in the cornea was displayed on the screen while the needle tip was inserted into the cornea. Simultaneously, the thickness of the cornea (including endothelial layer) below the needle tip was calculated and provided with a numerical value to the surgeon. To verify the feasibility of our device in big-bubble technique for DALK, the thickness of the remaining layer including the corneal endothelial layer was measured with the histology.
The big-bubble technique with the depth-sensing needle system was achieved in 18 of 21 cases (85.7%) for human cornea. The thickness of the remaining layer including the corneal endothelial layer was 24.5 µm (range 19–40). When the air was injected at more than 90% of the remaining depth for total corneal thickness, the big bubble was made as type II big bubble with clear margin.
The presented technology using the depth-sensing needle showed good results in terms of accuracy and efficiency in big-bubble technique for DALK. With further clinical practices, we believe that our device will break new ground in the field of lamellar keratoplasty including DALK or PDEK.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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