Intraoperative OCT may make corneal surgery safer

Dr. Carlos Lisa from Spain presented compelling evidence at ESCRS 2016 showing that intraoperative OCT may become an indispensable tool in corneal surgery.

While vitreoretinal surgeons have already seen the value of intraoperative OCT, interest is growing in applying the technology to keratoplasty procedures, such as DALK and DMEK, visualizing corneal pathology and implantation of phakic implantable contact lenses (ICL).

“Nothing and no one is indispensable, but intraoperative OCT is an excellent tool for making surgery safer,” Dr. Lisa said.

Showing video of a DMEK procedure and real-time OCT imaging side by side, he describes how he can easily determine which way the donor graft is oriented, correctly assessing the endothelial side of the graft in every step. He can also visualize the fluid interface and graft adherence. And in cases of compromised anterior chamber visualization, such as bullous keratopathy, he simply has more information.

“I can see the relation between the donor and host, and whether the donor is upside down. I can see the remnants of Descemet’s membrane preventing adherence. I can see the gap between the donor and host,” Dr. Lisa said. “I think it may improve the standardization and adoption of DMEK.”

In DALK procedures it could reduce the risk of perforation and may improve the reproducibility of the big-bubble procedure.

“We know exactly where we are before air injection. You always know what’s happening behind your incision,” he said, adding that his success rate with the big-bubble technique has improved significantly since using intraoperative OCT.

Intraoperative OCT provides more than pretty pictures, he said. Though still in its early stages, it could make surgery safer.