Intraoperative Optical Coherence Tomography Imaging in Corneal Surgery: A Literature Review and Proposal of Novel Applications

Figure 4

MIOCT images of DMEK cases. (a) Images of DMEK graft after insertion into the anterior chamber using a microscope-integrated slit-scan system. In the case of mild stromal oedema, the orientation of the DMEK graft can be ascertained (white arrow). (b) MIOCT images of the DMEK graft insertion into the anterior chamber. The graft orientation is clearly displayed as reverse even in the case of severe stromal oedema caused by Axenfeld–Rieger syndrome. In terms of images for decision-making, MIOCT images are much better than those of slit-scan systems. (c) Images after air injection for sticking the DMEK graft to the host cornea. The most peripheral part of the inserted DMEK graft in the anterior chamber is folded down. The MIOCT can display whether the graft folded toward the host or the anterior chamber. (d) Images of addressing the folded area by a scalpel. MIOCT image facilitates the manoeuvre of using the scalpel from the epithelial side. (e) MIOCT images of a DMEK graft, which never opened using any manoeuvre. The graft was curled strongly. MIOCT showed cloudiness inside the curled DMEK grafts, suggestive of viscous liquid which “glued” the graft on.

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