Intraoperative OCT in Anterior Segment Surgery

Intraoperative optical coherence tomography (OCT) has been a transformative technology for corneal surgery. This chapter illustrates its use for endothelial keratoplasty (EK), deep anterior lamellar keratoplasty (DALK), and for evaluating intraocular lens and Implantable Collamer Lens (ICL) placement. We use it most often for Descemet membrane endothelial keratoplasty (DMEK), and as a result, never have to place orientation marks on the donor tissue. The most transformative change has been with DALK, where feedback from the OCT allows the surgeon to obtain visual outcomes with manual/peeling dissection that can match the visual outcomes obtained with big bubble dissection. The iOCT™ enables the surgeon to see the OCT image in real time through the oculars rather than having to look away at a screen to see the OCT details. In DMEK cases, this allows the surgeon to see the graft orientation while the tissue is being manipulated, and in DALK cases, this allows the surgeon to see the depth of the peripheral dissection plane to make sure it is deep enough prior to starting a peel.