Original articleIntraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study
Section snippets
Methods
The DISCOVER study is a single-site, prospective multi-surgeon investigational device consecutive interventional case series. The study was approved by the Cleveland Clinic Institutional Review Board and adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all participants. The purpose of the DISCOVER study is to examine the feasibility and utility of a microscope-integrated intraoperative OCT system in both anterior and posterior segment surgery and identify
Clinical Results
Eight eyes of 7 patients (4 female, 3 male; mean age 74 years, range 49–88 years) that underwent DMEK in the DISCOVER study were included in this analysis. All surgeries were performed by a single surgeon (J.M.G.). Of note, these were the first DMEK cases performed by this surgeon (with or without intraoperative OCT). The median “un-scrolling time” (onset of intraocular graft manipulation until full apposition with 100% gas fill) was 6 minutes and 15 seconds (range 2:25–27:36). The median
Discussion
The field of intraoperative OCT is currently going through substantial growth and increased availability. Until recently, all systems that were commercially available in the United States were portable systems, such as the Bioptigen and Optovue systems.3, 6, 7 More recently there has been significant interest in microscope integration of this technology.4, 5, 8, 9, 10 There are 2 commercially available microscope integrated systems: the Haag-Streit integrated system and the Zeiss RESCAN 700.4, 8
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Cited by (49)
Re-descemet membrane endothelial keratoplasty (DMEK) with preservation of the original graft after free-roll in the anterior chamber: a case report
2024, Archivos de la Sociedad Espanola de OftalmologiaIntraoperative optical coherence tomography in anterior segment surgery
2021, Survey of OphthalmologyCitation Excerpt :Various methods and clinical signs have been described to facilitate correct graft orientation, including “S” or “F” stamps on the stromal aspect, double-ring sign for DSAEK lenticules, “Moutsouris” and “Minuteman” sign for DM scrolls.19,22 Additional surgical manipulation is required to mark the stromal aspect of grafts with dye stamps which is time consuming and can cause inadvertent tissue injury.17 Moreover, hazy corneas may impede visibility and hamper visualization of dye stamps or the clinical signs.27
Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases
2020, American Journal of OphthalmologyCitation Excerpt :As of this writing, however, there have been only 3 case series specifically evaluating the utility of iOCT in DMEK surgery. These reports demonstrated that iOCT was helpful in identifying remnants of Descemet membrane left on the host cornea, localizing the endothelial side of the donor graft, and facilitating tissue orientation when visualization is poor.7–9 These studies, however, were limited by small sample size (26, 14, and 8 patients) and did not report tissue unscrolling times.
Lamellar keratoplasty in children
2020, Survey of OphthalmologyCitation Excerpt :Correct orientation of donor lenticule can be secured by staining its endothelial side with trypan blue dye or stromal side with gentian violet dye. The use of i-OCT during EK can help in determining the need for any additional intraoperative manipulations to minimize interface fluid.23 According to our experience, it also helps in confirming graft centration, presence of interface fluid, and depth of vent incisions (Fig. 5B).
Intraoperative OCT for Lamellar Corneal Surgery: A User Guide
2023, Journal of Clinical Medicine
Supplemental Material available at AJO.com.