Novel intraoperative SD-OCT device improves surgical accuracy

LONDON — A novel, continuous, intraoperative spectral-domain optical coherence tomography device enhances control, accuracy and safety of surgical maneuvers in anterior segment surgery, according to one specialist.

After 3.5 years of previous experience with intraoperative time-domain anterior segment-OCT (Visante, Carl Zeiss Meditec), Oliver Findl, MD, has switched to the new Zeiss RESCAN 700 device, which incorporates a Cirrus OCT into the surgical microscope.

Oliver Findl

At the European Society of Cataract and Refractive Surgeons Congress, Findl showed examples of how OCT can display details of surgery not otherwise visible during routine cataract and corneal transplantation procedures.

One of these details was a gaping hole in the corneal wound and endothelium in the first hours following surgery, which OCT has shown to be quite typical of clear corneal incision, according to Findl.

“It is astonishing to see [during lens fragmentation] how often you have a touch of lens fragments on the endothelium, which you would not suspect from the video image,” he said.

The flutter of the capsule during surge, the stress along the incision during phacoemulsification and IOL implantation, and the thickening of the cornea to almost double in size during hydration were shown with remarkable clarity, according to Findl.

During Descemet’s stripping endothelial keratoplasty, OCT helps control the stripping of the membrane, the positioning of the graft, the air bubble and the outflow of fluid from the interface.

“You are able to see if there is still fluid remaining, and then you can massage the eye to squeeze it out,” Findl said.

Control of graft adhesion minimizes early graft dislocation and reduces re-bubbling rate to close to zero, he said.

Disclosure: Findl is a scientific advisor for Carl Zeiss Meditec but has no financial interest in the products mentioned.