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Rachel C Chen, Michael E. Millstein, Sunil K Srivastava, Jamie L. Reese, Justis P Ehlers; Intraoperative optical coherence tomography during cataract surgery in the DISCOVER study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):486. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Inadvertent injury of the corneal endothelium and posterior capsule are known complications of cataract surgery. Intraoperative optical coherence tomography (iOCT) is a new technology used to assess subtle anatomic details during ophthalmic surgery. This study aims to evaluate the feasibility of iOCT during the capsulorhexis and phacoemulsification steps of cataract surgery.
Subjects that underwent routine cataract surgery by a single surgeon enrolled in the DISCOVER study, an IRB-approved prospective consecutive case series, were identified. A microscope-integrated iOCT system was utilized. Static images visualizing the Utrata forcep tips and corneal endothelium were recorded at each re-grasp of the anterior capsular flap during capsulorhexis. Imaging of the posterior capsule was attempted during phacoemulsification at the deepest point of sculpting. Distance between forcep tips and corneal endothelium was measured using ImageJ. Preoperative anterior chamber depth was measured using Zeiss IOLMaster.
Twenty-seven eyes of 27 patients were enrolled. Imaging during the capsulorhexis and phacoemulsification steps were obtained for 24 and 27 eyes, respectively. Successful measurement of the distance between forcep tips and corneal endothelium was obtained in 61 of 109 attempts (55.9%). Success rate improved from 25 of 58 attempts (43.1%) in the first half of enrolled patients to 36 of 51 attempts (70.5%) in the second half. Reasons for unsuccessful measurements included discordance between scan location and forceps location (45.8%), incorrect focus (31.3%), and inability to visualize endothelium (22.9%). Median minimum distance between forcep tips and corneal endothelium was 0.85 mm (range 0.31 mm – 1.85 mm). Minimum distance was identified at the point closest to the main wound in 11 of 24 eyes (45.8%). Forceps did not touch the endothelium in any case. There was no correlation between preoperative anterior chamber depth and minimum distance between forceps and endothelium (Pearson’s r = 0.39, P=0.06). The posterior capsule was visualized in 6 eyes (22.2%).
Intraoperative OCT can be used to assess the distance between instruments and the corneal endothelium during cataract surgery. Consistent visualization of the posterior capsule remains challenging. Real-time imaging using iOCT may be helpful to provide rapid surgeon feedback on the instrument/tissue proximity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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