Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization

Area of Science:

• Ophthalmology
• Corneal Surgery
• Medical Imaging

Background:

• Corneal decompensation with poor visualization presents surgical challenges for endothelial keratoplasty.
• Descemet membrane endothelial keratoplasty (DMEK) requires precise graft placement, which can be difficult in compromised corneas.

Purpose of the Study:

• To evaluate the effectiveness of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing DMEK in eyes with limited visibility.
• To assess the impact of Mi-OCT guidance on graft attachment and visual outcomes in challenging DMEK procedures.

Main Methods:

• A prospective interventional case series involving 25 patients undergoing Mi-OCT-guided DMEK for corneal decompensation with poor visualization.
• Key outcome measures included graft attachment on postoperative day 3 and the need for re-bubbling, with a six-month follow-up.

Main Results:

• Complete graft attachment was achieved in 72% of cases, with 16% requiring re-bubbling due to detachment. All grafts were attached at six months.
• Mi-OCT facilitated visualization of anatomical structures, graft configuration, and potential complications like peripheral folds and retained tags.
• Significant improvements were observed in corrected distance visual acuity and central corneal thickness post-surgery.

Conclusions:

• Mi-OCT is a valuable tool for DMEK surgery in corneas with poor visualization, aiding in the identification of host anatomy and graft dynamics.
• The use of Mi-OCT can lead to successful graft attachment and improved visual function in challenging endothelial keratoplasty cases.