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Brian Cost, Katie Marie Hallahan, William J Dupps, Jeff Goshe, Sunil K Srivastava, Justis P Ehlers; Intraoperative OCT-assisted DSAEK Surgery in the PIONEER Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1575.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the role of intraoperative optical coherence tomography (iOCT) during Descemet stripping automated endothelial keratoplasty (DSAEK) in the PIONEER (Prospective Intraoperative and Perioperative Ophthalmic ImagiNg with Optical CohEncE TomogRaphy) study.
The PIONEER study is a multi-surgeon prospective IRB-approved study that assessed iOCT feasibility and utility in ophthalmic surgery. This analysis includes eyes undergoing DSAEK from PIONEER. Clinical characteristics and outcomes were assessed up to 6 months post-operatively. iOCT images were captured at multiple time points during surgery. A novel automated algorithm evaluated intraoperative dynamics of interface fluid following surgical manipulations.
Two hundred-one eyes of 174 patients (129 female, 73 male) with mean age of 71 (range: 21-95) were included. The most common indications were Fuchs Endothelial Dystrophy (65%), Bullous Keratopathy (20%) and previously failed DSAEK (8%). The most common previous surgeries on the study eye were vitrectomy (10%), previous DSAEK (9%) and aqueous tube shunts (7%). Mean preoperative visual acuity was 20/132, which improved to 20/46 following surgery (p < 0.0001). There were 16 (8%) graft dislocations, of which 11 eyes had at least one ocular comorbidity (p = 0.0007). Significant interface fluid was often present following graft placement. Fluid volume changed notably during intraoperative manipulations (Figure 1) with a mean decrease of 0.449 µL (range -0.175-4.715 µL). Postoperative interface haze was found in 24% of patients at POM#1, 18% at POM#3, and 11% at POM#6 and was associated with postoperative residual interface fluid. Surgeon feedback indicated that iOCT informed surgical decision-making and altered understanding of graft apposition in 118 out of 201 cases (59%).
iOCT-assisted DSAEK surgery provides new information about the amount and location of interface fluid following graft placement. This may facilitate surgical maneuvers to minimize residual interface fluid prior to completing surgery which may reduce the risk of postoperative interface haze and speed visual recovery. Ocular comorbidities appear to be an important factor in DSAEK graft dislocation.
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