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Claus Cursiefen, Eva Lankenau, Marc Krug, Gereon Huettmann, Stephan Oelckers, Philip Steven; Intraoperative Optical Coherence Tomography Improves Surgical Performance In Descemet Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2012;53(14):20.
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Descemet membrane endothelial keratoplasty (DMEK) has recently been introduced to restore corneal transparency in patients with corneal endothelial diseases by selectively replacing diseased endothelium. DMEK requires precise handling and orientation of the delicate graft within the anterior chamber to avoid peri- or postoperative graft dislocation. This case series evaluates the use of intraoperative OCT (iOCT) to visualize the graft within the anterior chamber during orientation and attachment to the posterior cornea.
Intraoperative OCT (iOCT, OptoMedical Technologies GmbH, Luebeck, Germany in cooperation with Moeller-Wedel, Wedel, Germany) was used in 9 consecutive patients suffering from corneal endothelial dysfunction undergoing DMEK. Evaluation parameters included iOCT-visualization of Descemet’s membrane rolling behaviour immediately after preparation, Descemet’s membrane rolling inside the eye, and attachment to posterior stroma after insertion and air insufflation.
In all patients Descement’s membrane was readily visible within the anterior chamber thus enabling precise visualization of membrane unfolding and correct orientation in all patients. Rolling behavior correlated inversely with donor age with younger donor tissue showing strongest inward rolling activity. Unfolding and complete attachment to the posterior surface of the recipient cornea was visualized and controlled by iOCT thus allowing for a shortening of complete intraoperative air filling time.
Use of intraoperative OCT is helpful to locate and orientate DMEK grafts within the recipient’s anterior chamber. Visualization of the graft by iOCT prevents incorrect unfolding or orientation and aids the surgeon to verify complete graft attachment at the end of the procedure and also reduces complete air filling time.
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