Use of Integrated Intraoperative Optical Coherence Tomography in Pediatric Cornea Surgery
Sapna Tibrewal; Andrew Troia; Ladan Espandar; Kanwal K. Nischal
Children’s Hospital of Pittsburgh of UPMC
Introduction: We describe our experience with the use of a microscope integrated intraoperative optical coherence tomography (i2OCT) for pediatric cornea surgery, and its effect on achieving intended surgical procedures.
Methods: Retrospective case note and video review of all children undergoing corneal transplant surgery in whom i2OCT was used at CHP.
Results: Penetrating Keratoplasty (PK, n = 3), Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK, n = 6), and Deep Anterior Lamellar Keratoplasty (DALK, n = 3) surgeries were performed with the use of i2OCT. Indications were mucopolysaccharidoses (DALK), peter’s anomaly (PK), haab’s striae, endothelial dystrophy or corneal decompensation following pediatric cataract or glaucoma surgeries (DSAEK). All cases of DSAEK and DALK were successfully completed as intended. i2OCT allowed a better evaluation of graft-host junction for proper apposition in cases of PKP, improved visualization of the endothelial graft in opaque corneas for DSAEK and allowed delineation of the posterior stroma Descemet membrane separation for cases of DALK.
Discussion: i2OCT offers a reliable method of real time imaging during pediatric cornea surgeries, and enables view of structures that could not be seen with a surgical microscope.
Conclusion: i2OCT is a useful tool in pediatric cornea surgeries, especially as these are often more difficult surgeries due to unpredictable and distorted anatomy. It increases the likelihood of completing the intended procedure as planned, as well as flattens the learning curve for surgeons dealing with children’s corneal diseases.