June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Comparative Outcome Assessment of Descemet Membrane Endothelial Keratoplasty with and without Intraoperative Optical Coherence Tomography Guidance from the DISCOVER study
Author Affiliations & Notes
  • Ryan Jaber
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Jeffrey Goshe
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Scott Wagenberg
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Ming Hu
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Sunil K Srivastava
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Jamie Reese
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Justis Ehlers
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Ryan Jaber, None; Jeffrey Goshe, None; Scott Wagenberg, None; Ming Hu, None; Sunil Srivastava, Alcon (C), Allergan (F), Bausch and Lomb (C), Bausch and Lomb (P), Bioptigen (P), Leica (P), Santen (C), Synergetics (P), Zeiss (C); Jamie Reese, None; Justis Ehlers, Alcon (C), Alcon (F), Alimera (C), Allergan (C), Bausch and Lomb (P), Bioptigen (C), Bioptigen (P), Genentech (C), Genentech (F), Leica (C), Leica (P), Regeneron (F), Santen (C), Synergetics (P), Thrombogenics (C), Thrombogenics (F), Zeiss (C)
  • Footnotes
    Support  This study was supported in part by NIH/NEI K23-EY022947-01A1; Ohio Department of Development TECH-13-059; NIH-NEI P30 Core Grant (IP30EY025585-01A1) and Unrestricted Grant from The Research to Prevent Blindness, Inc., awarded to the Cole Eye Institute. ​​​​​​​
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5668. doi:
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      Ryan Jaber, Jeffrey Goshe, Scott Wagenberg, Ming Hu, Sunil K Srivastava, Jamie Reese, Justis Ehlers; Comparative Outcome Assessment of Descemet Membrane Endothelial Keratoplasty with and without Intraoperative Optical Coherence Tomography Guidance from the DISCOVER study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5668.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Intraoperative optical coherence tomography (iOCT) allows real-time visualization of donor lenticule orientation during Descemet membrane endothelial keratoplasty (DMEK). The purpose of this study is to evaluate the potential impact of iOCT on DMEK outcomes.

Methods : The DISCOVER study is a prospective microscope-integrated iOCT study to evaluate the feasibility and utility of iOCT in ophthalmic surgery. To date, 45 DMEK cases have been enrolled in the DISCOVER study. These cases represent the first 45 DMEK cases performed by the surgeon in DISCOVER. An IRB-approved case-control retrospective evaluation was performed that included 45 separate cases without iOCT feedback that were the first 45 cases performed by a second surgeon. Clinical characteristics and outcomes were compared between the groups with a particular focus on the primary graft failure rate and rebubble rate.

Results : The iOCT subjects (n=45 eyes) had a mean age of 70.2 years (SD=10.1). There were 5 (11.1%) cases of rebubbling that were subsequently successfully reattached. There were 2 (4.4%) primary graft failures, including 1 case secondary to postoperative pupillary block. Overall, there were 7 cases (15%) that required early postoperative surgical interventions.

The non-iOCT subjects (n=45 eyes) had a mean age of 69.0 years (SD=12.6). There were 7 (15.5%) cases of rebubbling that were subsequently successfully reattached. There were 6 (13.3%) primary graft failures. Overall, there were 13 cases (28%) that required early postoperative surgical interventions.

There were no significant differences between the two groups in rebubble rate although there was a trend towards a reduction in primary graft failures and postoperative surgical intervention in the iOCT group.

Conclusions : The rate of postoperative intervention rate was 15-28%. Although there was a trend towards reduced primary graft failure and postoperative surgical intervention in the iOCT group, there were no significant differences between these rates. Additional prospective randomized research is needed with an appropriate sample size to better define the role of iOCT in DMEK surgery.

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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