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Year : 2023  |  Volume : 13  |  Issue : 1  |  Page : 106-109

Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty

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
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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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