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Intraoperative use of spectral-domain optical coherence tomography for optimal endothelial graft creation during ultra-thin Descemet's stripping and automated endothelial keratoplasty

Session Details

Session Title: Cornea

Session Date/Time: Sunday 17/02/2013 | 08:30-11:00

Paper Time: 09:52

Venue: Hall 2

First Author: : E.Wylęgała POLAND

Co Author(s): :    D. Tarnawska   B. Wowra   E. Wrףblewska Czajka        

Abstract Details


Despite of existing nomograms that facilitate the proper choice of microkeratome head for preparing endothelial graft during ultra thin- Descemet’s stripping and automated endothelial keratoplasty (UT-DSAEK), there are several patient-related and surgeon-related factors that could influence the thickness of the graft. Ultrasonic pachymetry measurements are not always accurate and may vary with surgeon’s technique and calibration of the device. The aim of the study was to evaluate the intraoperative changes of the donor lenticule thickness during double-pass UT-DSAEK, using intraoperative spectral-domain optical coherence tomography.


1. Department of Biophysics and Molecular Physics, Institute of Physics, University of Silesia, Katowice, Poland 2. Ophthalmology Dept., Railway Hospital, Katowice, Poland


Prospective observational case series of patients underwent UT-DSAEK. Spectral-domain optical coherence tomography movable device was used to image the donor cornea and to measure its thickness before, after 1st and 2nd microkeratome pass. During the flap creation the decision of the choice of the microkeratome head size was taken on the basis of initial pachymetry for the first cut, and on the basis of the second pachymetry measurement for the refinement cut. The cornea and graft thickness were also measured at the end of surgery and graft-host interface was assessed.


Fourteen UT-DSAEK surgeries were OCT imaged intraoperatively. The patients mean age was 72.1 ± 9.7 years. 10 were female and 4 were male. The mean initial donor cornea thickness was 634 μm ± 93 μm, the mean thickness after the first pass was 372 ± 102 μm, and after the second pass it was 92 ± 38 μm. There were no tissue lost. In 3 eyes we decided to perform 1-2 venting incisions for interface fluid expression because of the size of the interface gap measured with OCT at the end of the surgery. In remaining 11 eyes there was no need to performed the venting incision because there was no gap at the tissue interface, visible on OCT image.


Intraoperative imaging with spectral-domain OCT during UT- DSAEK provides exact information about the depth of the microkeratome cut and about the thickness of remaining corneal tissue (double check). It enables to create very thin graft without risk of tissue lost, and therefore provides the greater accuracy and predictability of the surgery outcomes.

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