There is a wide range of anterior-segment (AS) imaging technologies on the market today. Some AS imaging devices are better than others in anterior-segement surgeries, and surgeons must decide which options are best suited for their practices.
The usefulness of intraoperative OCT technology also was evaluated in a prospective multi-surgeon study that included 244 cases of AS surgery.
The results indicated that the technology influenced surgical decision-making in 43.4% of cases; 78.3% of surgeons preferred real-time to static image acquisition; and 63.1% of surgeons preferred viewing the images on the external screen.
The limitations of intraoperative OCT include limited details visible on the heads-up display, light scattering and shadowing from surgical instruments, and cost.
AS-OCT facilitates assessment of grafts in DSAEK and DMEK for thickness, centration, and detachment. This technology influences management considerations such as graft reshaping and repositioning and rebubbling.
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AS-OCT technology allows the surgeon to assess the graft-host junction after penetrating keratoplasty, in which graft-host malpositioning occurs commonly and is associated with high levels of astigmatism.
Dr. Patel described the case of a patient in whom the vision decreased a few years after deep anterior lamellar keratoplasty due to recurrent granular dystrophy at the interface.
AS-OCT is also useful for evaluating the extent of epithelial ingrowth, albeit rare, following lamellar endothelial keratoplasty.
The technology is also used to monitor patients over time.
IVCM has proven useful to confirm cases of epithelial ingrowth. Dr. Patel described an interesting case in which the IVCM images showed epithelial cells with fibrotic areas in the stroma, where epithelium should not be present, Dr. Patel explained.
IVCM and specular microscopy are both useful technologies that can be used to determine the prognosis as well as the potential for late endothelial graft failure.
Two long-term studies investigating graft failure after full-thickness or endothelial transplants both found that preoperative donor endothelial density is not predictive of failure, but rather, low endothelial cell density (<1,200 cells/mm2) 6 months postoperatively is associated with late endothelial graft failure.
For physicians, AS-OCT is opening new doors to ensure the fast and efficient diagnosis and treatment of patients.
This, according to Dr. Patel, can lead to better outcomes for their vision.
“UBM, AS-OCT, intraoperative OCT, IVCM, and specular microscopy are useful for establishing a diagnosis, directing the management and assessing the prognoses of these patients,” Dr. Patel concluded.
Dipika V. Patel, MRCOpht, PhD
E: [email protected]
Dr. Patel has no financial interest to any aspect of this report.