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Moramarco A, di Geronimo N, Airaldi M, Gardini L, Semeraro F, Iannetta D, Romano V, Fontana L. Intraoperative OCT for Lamellar Corneal Surgery: A User Guide. J Clin Med 2023; 12:jcm12093048. [PMID: 37176489 PMCID: PMC10179477 DOI: 10.3390/jcm12093048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Intraoperative OCT is an innovative and promising technology which allows anterior and posterior segment ocular surgeons to obtain a near-histologic cross-sectional and tomographic image of the tissues. Intraoperative OCT has several applications in ocular surgery which are particularly interesting in the context of corneal transplantation. Indeed, iOCT images provide a direct and meticulous visualization of the anatomy, which could guide surgical decisions. In particular, during both big-bubble and manual DALK, the visualization of the relationship between the corneal layers and instruments allows the surgeon to obtain a more desirable depth of the trephination, thus achieving more type 1 bubbles, better regularity of the plane, and a reduced risk of DM perforation. During EK procedures, iOCT supplies information about proper descemetorhexis, graft orientation, and interface quality in order to optimize the postoperative adhesion and reduce the need for re-bubbling. Finally, mushroom PK, a challenging technique for many surgeons, can be aided through the use of iOCT since it guides the correct apposition of the lamellae and their centration. The technology of iOCT is still evolving: a larger field of view could allow for the visualization of all surgical fields, and automated tracking and iOCT autofocusing guarantee the continued centration of the image.
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Affiliation(s)
- Antonio Moramarco
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Matteo Airaldi
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Francesco Semeraro
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Vito Romano
- Eye Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
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Muijzer MB, Delbeke H, Dickman MM, Nuijts RM, Noordmans HJ, Imhof SM, Wisse RPL. Outcomes of the advanced visualization in corneal surgery evaluation trial; a non-inferiority randomized control trial to evaluate the use of intraoperative OCT during Descemet membrane endothelial keratoplasty. FRONTIERS IN OPHTHALMOLOGY 2023; 2:1041778. [PMID: 38983542 PMCID: PMC11182175 DOI: 10.3389/fopht.2022.1041778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/09/2022] [Indexed: 07/11/2024]
Abstract
Objective To evaluate if an intraoperative-OCT (iOCT) optimized surgical protocol without prolonged overpressure is non-inferior to a standard protocol during Descemet membrane endothelial keratoplasty (DMEK). Methods Sixty-five pseudophakic eyes of 65 patients with Fuchs endothelial dystrophy scheduled for routine DMEK were recruited in this prospective non-inferiority international multicenter randomized control trial. Subjects were randomized to the control arm (n=33) without iOCT-use and raising the intraocular pressure above normal physiological limits for 8 minutes (i.e., overpressure) or the intervention arm (n=32) with OCT-guidance to assess graft orientation and adherence, while refraining from prolonged overpressure. The primary outcome was the incidence of postoperative surgery-related adverse events (AE). The non-inferiority margin was set at a risk difference of 10%. Secondary outcomes included iOCT-aided surgical decision making, surgical times, and endothelial cell density (ECD) corrected distance visual acuity (CDVA) at 6 months follow-up. Results In the intervention group, 12 subjects developed 13 AEs compared to 13 AEs in 10 subjects in the control group (P=0.644). The risk difference measured -0.32% (95%CI: -10.29 - 9.84). The ECD and CDVA did not differ between the two groups 3 and 6 months postoperatively (P=>0.05). Surgeons reported that iOCT aided surgical decision-making in 40% of cases. Surgery and graft unfolding time were, respectively, 13% and 27% shorter in the iOCT-group. Conclusions iOCT-guided DMEK surgery with refraining from prolonged over-pressuring was non-inferior compared to conventional treatment. Surgery times were reduced considerably and iOCT aided surgical decision-making in 40% of cases. Refraining from prolonged overpressure did not affect postoperative ECD or CDVA. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03763721 (NCT03763721).
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Affiliation(s)
- Marc B. Muijzer
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen Delbeke
- Ophthalmology Department, University Hospital Leuven, Leuven, Belgium
- Katholieke Universiteit (KU) Leuven, Biomedical Sciences Group, Department of Neurosciences, Research group Ophthalmology, Leuven, Belgium
| | - Mor M. Dickman
- University Eye Clinic, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rudy M.M.A. Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, Netherlands
| | - Herke Jan Noordmans
- Medical Technical and Clinical Physics Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saskia M. Imhof
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert P. L. Wisse
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, Netherlands
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