| CASE REPORT |
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| Year : 2023 | Volume
: 13
| Issue : 1 | Page : 106-109 |
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Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty
Charles C Lin, Wen-Shin Lee
Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
Correspondence Address:
Dr. Charles C Lin
2452 Watson Court, Palo Alto, CA 94303
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjo.TJO-D-22-00151
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Gauging stromal dissection depth is crucial to successfully perform deep anterior lamellar keratoplasty (DALK) surgery. Intraoperative optical coherence tomography (iOCT) offers a promising tool to aid DALK surgery but visualization of surgical maneuvers is impaired due to artifacts from metallic instruments. We describe a novel surgical technique utilizing suture-assisted iOCT guidance that facilitates clear visualization of corneal dissection planes during DALK. A stromal dissection tunnel is performed with a Fogla probe and its depth is subsequently identified by threading a 1 cm segment of 8-0 nylon into the tunnel. In contrast to the Fogla probe, the 8-0 nylon is conspicuously highlighted on iOCT. If the tunnel is too superficial, a separate, deeper stromal tunnel can be created and visualized again with the 8-0 nylon suture and iOCT. This iterative process facilitates a deep stromal dissection, increasing the probability of successful big-bubble formation and Descemet baring DALK surgery. This technique was utilized for a successful big-bubble DALK in a patient with severe keratoconus.
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