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  • Intraoperative OCT for Tissue Orientation in DMEK

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, February 2020

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    In a report on the first 100 cases of the DISCOVER study, which included “learning curve” operations, Patel et al. noted that intraoperative optical coherence tomography (iOCT) facil­itated tissue orientation in Descemet membrane endothelial keratoplasty (DMEK) and eliminated the need for external markings. Even for novice DMEK surgeons, the complication rates and unscrolling times compared favorably with those of other tissue-orientation methods.

    DISCOVER was a single-center study of 100 eyes (76 patients) in which iOCT was used for tissue orientation. A ques­tionnaire was completed by attending surgeons to gauge the impact and value of iOCT in this operative setting. Main outcome measures were the perceived utility of iOCT, graft unscrolling effi­ciency, and the frequency of post-op complications.

    Forty-three operations were per­formed by a staff physician, and the remainder by six novice surgeons (cornea fellows under supervision). Fifty-two eyes received concurrent phacoemulsifcation with lens implan­tation. Nine eyes required rebubbling, resulting from poor post-op adherence of the graft. The rebubbling rate was slightly lower for cornea fellows (8.9%) than for the primary surgeon (9.5%). These rates are significantly lower than the average of 17 studies that did not include iOCT (28.8%).

    The graft was easily visualized in all 100 eyes, including three in which an S-stamp was present but could not be readily discerned. Primary graft failure occurred in two eyes: In one, the graft was inverted due to iOCT misinterpre­tation by the surgeon; the other failure was ascribed to poor-quality tissue. The average unscrolling time was 4.4 ± 4.1 minutes (range, 0.7-27.6 minutes), which compares favorably with that of previous reports.

    These findings support the potential value of iOCT for DMEK procedures, said the authors. This technology may reduce the DMEK learning curve and help both novice and veteran surgeons to achieve excellent results. The authors noted that a randomized controlled trial of iOCT-assisted surgery versus S-stamp surgery may shed further light on the possible link between S-stamping and postoperative rebubbling.

    The original article can be found here.