Eyeworld

66 | EYEWORLD | MARCH 2020 I ILLUMINATING INTRAOPERATIVE TECHNOLOGIES N FOCUS Contact Findl: oliver@findl.at Schallhorn: jschallhorn@gmail.com Tassignon: marie-jose.tassignon@uza.be anterior interface dysgenesis since in these cases there is an abnormality in the development of the anterior hyaloid and the posterior capsule," she said. "The repair mecha- nism to compensate for this dysgenesis resulted in a poste- rior cataract, which has been recognized as a separate pediatric cataract entity." Looking forward Intraoperative OCT, Dr. Tassignon said, will hopefully answer remaining questions such as the size of the anterior interface and the role of an AVD on post-cataract cystoid macular edema or retinal detachment. Meanwhile, Dr. Findl hopes for further technological developments, such as an entire eye OCT, perhaps some robot- ic automation, and plastic instruments that do not cast shadows on OCT images. Something concrete to look forward to is an intraoperative OCT course that Dr. Schall- horn, Charles Lin, MD, and Matthew Feng, MD, are designing for the 2020 ASCRS An- nual Meeting. The course will cover the basic design and use of the various commercially available intraoperative OCT microscopes and will include a wet lab for OCT use in lamellar corneal surgery. This will be a great opportunity to learn about a technology that Dr. Schallhorn expects will have an expanding role in practice. "Because of the unique advantages of OCT over direct visualization (cross-sectional image, longer light wavelength), it adds to the surgeon's understanding of what is happening during an operation," she said. "I expect that it will even- tually become routine to use OCT during most types of surgery." to identify the pres- ence of a thickened macula, epiretinal membrane, thickened and/or adherent internal limiting membrane (ILM), or cystoid macular ede- ma. During peeling, it allows him to see the tension he's putting on the retina, allow- ing him to adjust his technique. "Last but not least, I like to use it for macular hole surgery because we like to do the ILM flap technique, where we put a part of the ILM flap on top of the macular hole, especially for large macular holes," he said. "For that it's quite nice because you can actually see the flap, and when you're introducing air into the eye, you can see and control the position of the flap until the very end when you have a complete air fill." Training, general applications For training purposes, Dr. Findl and Dr. Schall- horn both said their residents learn to operate using standard surgical microscopes, without intraoperative OCT. However, intraoperative OCT is useful for evaluating their performance. The technology, however, is "100% use- ful for experienced surgeons," Dr. Schallhorn said. "I find it most useful in my corneal cases and have been surprised at times by how much fluid is left in the graft interface when it looks perfectly attached to me." An additional use for intraoperative OCT in Dr. Findl's hands would be for OVD removal. "The problem with OVDs is they are very sim- ilar to water—the refractive index of OVD and water is quite similar—so in my hands I don't see the interface well," he said. Finally, Dr. Tassignon reiterated the technology's utility in observing the anterior interface. "It predicts the degree of surgical difficulty in cases of pediatric cataract with References 1. Tassignon MJ. The history of the anterior interface. Innovative Implantation Technique: Bag- in-the-Lens Cataract Surgery. Springer Nature. 2019:25–32. 2. Tassignon MJ. Clinical variations of the vitreo-lenticular interface. Innovative Implantation Technique: Bag-in-the-Lens Cat- aract Surgery. Springer Nature. 2019:33–44. 3. Tassignon MJ, Ni Dhubhghaill S. Real-time intraoperative optical coherence tomography imaging confirms older concepts about the Berger space. Ophthalmic Res. 2016;56:222–226. Relevant disclosures Findl: Alcon, Johnson & Johnson Vision, Carl Zeiss Meditec Schallhorn: Carl Zeiss Meditec Tassignon: Intellectual and proprietary interests in the bag-in-the-lens technique continued from page 64 "I expect that it will eventually become routine to use OCT during most types of surgery." —Julie Schallhorn, MD

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