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Philipp Steven, Eva Lankenau, Marc Krug, Gereon Huettmann, Stefan Oelckers, Claus Cursiefen; Intraoperative Optical Coherence Tomography Improves Surgical Performance In Deep Anterior Lamellar Keratoplasty (DALK) and penetrating Keratoplasty (pKPL). Invest. Ophthalmol. Vis. Sci. 2012;53(14):19.
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Corneas of patients with keratoconus, excessive scarring, ulceration etc. require adapted replacement of diseased tissue, either in part or totally. Lamellar techniques such as Deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (pKPL) are performed to restore corneal integrity and transparency. In both techniques optimal graft alignment ensures best visual outcomes. This case series evaluates the use of intraoperative OCT (iOCT) to support lamellar preparation in DALK and graft alignment in both DALK and pKPL.
Intraoperative OCT (iOCT, OptoMedical Technologies GmbH, Luebeck, Germany in cooperation with Moeller-Wedel, Wedel, Germany) was used in one patient undergoing DALK and 6 patients undergoing pKPL. Evaluation parameters included iOCT-visualization of trephination depth, needle location, big-bubble effect and thickness of remaining stromal tissue in DALK and graft alignment as well as surface steps in both DALK and pKPL.
During DALK, trephination depth was visualized and injection needle could be located in the designated tissue plane. Big-bubble formation was also visualized followed by preparation of the posterior lamellar. Thickness of remaining stromal tissue can be visualized and measured. Deep stromal pre-Descemetic air bubbles could be visualized. Graft alignment was visualized both in DALK and pKPL and interface steps were avoided according to the intraoperative OCT display.
Use of intraoperative OCT is helpful to verify trephination depth and needle insertion in DALK for precise identification of the accurate preparation depth. Visualization of the interface shape aids the surgeon to avoid tissue steps and in case of DALK complete attachment of the graft to the donor lamellar.
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