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Paramjit Bhullar, Oscar Carrasco-Zevallos, Alexandria Dandridge, Neel Pasricha, Brenton Keller, Liangbo Shen, Joseph A Izatt, Cynthia A Toth, Anthony N Kuo; Intraocular Pressure and Big Bubble Diameter in Deep Anterior Lamellar Keratoplasty: An Ex-Vivo Microscope-Integrated OCT with Heads-Up-Display Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5662. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the relationship between intraocular pressure (IOP) and big bubble (BB) formation in an ex-vivo model of deep anterior lamellar keratoplasty (DALK).
Corneo-scleral buttons from human donors were loaded onto an artificial anterior chamber connected to a column of balanced salt solution. A surgeon-in-training learned to perform DALK via Anwar and Teichmann’s BB technique using swept-source microscope-integrated optical coherence tomography with heads-up-display (SS-MIOCT with HUD). DALK procedures were performed at one of six different IOPs (5, 10, 15, 20, 30, or 40mmHg; n=6 per group) in a randomized fashion, with the surgeon-in-training masked to the pressure and guided by SS-MIOCT with HUD. For a subset of corneas within each pressure group, DALK was performed on matching donor tissue at a control IOP. BB formation was assessed (Figure 1A-B) and diameter was recorded. A BB diameter exceeding the trephine diameter was considered optimal.
Wilcoxon rank sum test showed a difference in BB diameter amongst the different pressure groups (mean±standard deviation of 7.75±1.60mm, 8.33±1.99mm, 10.9±0.92mm, 9.08±1.07mm, 6.67±3.33mm, and 3.42±3.77mm in the 5, 10, 15, 20, 30, and 40mmHg groups, respectively; p=0.0014). Per Tukey test, this difference was attributable to comparisons between the 40mmHg group and the 5, 10, 15, or 20mmHg groups (p=0.04, 0.02, 0.0001, 0.004, respectively). See Figure 1C-D.
In this ex-vivo model of DALK, the BB technique guided by SS-MIOCT with HUD yielded bubbles of optimal diameters only at physiologic pressures (10-20mmHg). Extremely high IOP (40mmHg) resulted in BBs of significantly smaller diameter than BBs obtained at physiologic and low (5mmHg) IOPs.
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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