Intraoperative OCT-assisted DMEK positively impacts efficiency
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Intraoperative OCT-assisted Descemet’s membrane endothelial keratoplasty gives surgeons a direct assessment of the graft orientation and apposition, which increases the safety and efficiency of the surgery, according to a study.
“The availability of intraoperative OCT enabled us to critically evaluate and revise our practice patterns,” Marc B. Muijzer, BSc, told Healio/OSN. “The promising outcomes of our study show that using intraoperative OCT altered surgical decision-making in 42% of surgeries and improved surgical efficiency by refraining from pressurizing the eye without compromising safety.”
Muijzer and colleagues evaluated the surgical safety, efficiency and surgical outcomes of DMEK when using a microscope-integrated OCT (Lumera 700 OPMI Rescan, Zeiss GmbH) intraoperatively.
A total of 38 cases were included, all performed by the same surgeon and all with 6 months of follow-up. Primary outcome was adverse events, with critical decision-making and surgery time evaluated as secondary outcomes. The surgeon used iOCT in all cases to determine apposition, assessment of interface fluid and graft orientation.
In one group of 16 grafts that underwent a standard period of prolonged overpressure of the globe of at least 12 minutes, seven (43.6%) adverse events were recorded, including four graft dislocations that needed rebubbling. In 22 eyes that underwent brief overpressure of 2 minutes at most, four (18.1%) adverse events were recorded, three of which were graft dislocations needing rebubbling.
In all 38 cases, graft orientation was correctly determined using iOCT, providing additional information when orientation was unclear or incorrect, and showing interface fluid and minor graft detachments not visible using an en face microscope view.
“These results are currently being validated in the prospective ADVISE trial,” Muijzer said.
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