Eyeworld

64 | EYEWORLD | MARCH 2020 I ILLUMINATING INTRAOPERATIVE TECHNOLOGIES N FOCUS This application, however, requires a prototype swept-source OCT not yet ready for commercial use, Dr. Findl said. Implications for bag-in-the-lens technique The information on the anterior interface that intraoperative OCT provides has had a particu- lar impact on Dr. Tassignon's practice. Having intellectual and proprietary interests in the bag-in-the-lens (BIL) technique, Dr. Tassignon has routinely used this method to implant IOLs since 2004. "This technique requires performing a primary posterior circular, continuous capsu- lorhexis (PPCCC)," she said. While considered standard in pediatric cases, PPCCC had been "enigmatic" for most cataract surgeons because no one knew the precise anatomy of the anteri- or interface. "With the advent of the intraoper- ative OCT, our group was able to describe the fascinating variations of the anterior interface from birth till adulthood and to evaluate its aging process," she said. "It became evident that this anterior interface changes over time and becomes bigger and bigger until it detaches from the posterior capsule. This process was called anterior vitreous detachment, which is the equivalent of the posterior vitreous detachment (PVD)." 3 Corneal surgery Dr. Schallhorn uses intraoperative OCT in all of her lamellar corneal cases, including DSAEK, DALK, and DMEK. "It is great to see if there is any fluid in the interface in DSAEK cases and to check if there are any peripheral Descemet's remnants that are preventing the DMEK graft from adhering 100%," she said. "It is invaluable in DALK cases to check the depth of your can- nula before the big bubble and to ensure that all the stroma has been removed prior to placing the graft." "Intraoperative OCT is helpful in all condi- tions of corneal surgery," Dr. Tassignon agreed. For any residual interface fluid in DSAEK, she and Dr. Findl described performing a corneal massage or creating venting incisions under OCT control. "You can be sure that at the end of surgery you don't have fluid interface About the doctors Oliver Findl, MD Chair and associate professor of ophthalmology Hanusch Hospital Vienna, Austria Julie Schallhorn, MD Assistant professor of ophthalmology University of California, San Francisco San Francisco, California Marie-Jose Tassignon, MD Chair Department of Ophthalmology Antwerp University Hospital Antwerp, Belgium continued on page 66 continued from page 63 Image from the RESCAN (Carl Zeiss Meditec) of a difficult cataract case in a patient with Stevens-Johnson syndrome and a large corneal scar. OCT was helpful in visualizing the capsulorhexis through the dense scar. Source: Julie Schallhorn, MD between the transplant and recipient cornea," Dr. Findl said. The technology is also useful for orienting the rolled donor tissue during DMEK. "Once you're unfolding that, you can see quite well whether it's the right way up or upside down," Dr. Findl said. Retina Intraoperative OCT plays a major role in Dr. Findl's retina cases. The technology allows him

• Blank Page
• Blank Page (1)