Pasricha Neel D, Shieh Christine, Carrasco-Zevallos Oscar M, Keller Brenton, Cunefare David, Mehta Jodhbir S, Farsiu Sina, Izatt Joseph A, Toth Cynthia A, Kuo Anthony N
*Department of Ophthalmology, Duke University School of Medicine, Durham, NC; †Department of Biomedical Engineering, Duke University, Durham, NC; ‡Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore; and §Duke-NUS Graduate Medical School, Singapore.
Cornea. 2016 Nov;35(11):1471-1477. doi: 10.1097/ICO.0000000000000948.
To examine big-bubble (BB) formation success rates in deep anterior lamellar keratoplasty (DALK) at various corneal depths using real-time guidance from swept-source, microscope-integrated optical coherence tomography (SS-MIOCT).
The DALK procedure was performed ex vivo with 34 human donor corneoscleral buttons on pressurized artificial anterior chambers using the BB technique employed by Anwar and Teichmann. We inserted a needle under controlled ex vivo conditions to corneal depths ranging from 40% to ≥90% using real-time guidance from SS-MIOCT and injected air. BB success was then determined for each injection.
The average needle depth for successful full BB formation was 79.9% ± 3.0% compared with 66.9% ± 2.6% for partial BB formation and 49.9% ± 3.4% for no BB formation (P < 0.0001). Expressed as stroma below the needle tip, this corresponded to 123.9 ± 20.0 μm for successful full BB formation compared with 233.7 ± 23.8 μm for partial BB formation and 316.7 ± 17.3 μm for no BB formation (P < 0.0001). All other variables tested (sex, race, age, endothelial cell density, air injected, needle angle, and central corneal thickness) did not significantly affect BB formation success rates.
BB formation in DALK is more successful if needle insertion and air injection occur at deeper corneal depth. However, ≥90% corneal depth was not necessary in this ex vivo model of DALK. SS-MIOCT can be used to accurately guide the needle in real time.
利用扫频源、显微镜集成光学相干断层扫描(SS-MIOCT)的实时引导,研究不同角膜深度的深板层角膜移植术(DALK)中大气泡(BB)形成的成功率。
使用Anwar和Teichmann的BB技术,在加压人工前房上对34个人类供体角膜巩膜纽扣进行离体DALK手术。我们在离体条件下,利用SS-MIOCT的实时引导,将针插入角膜深度为40%至≥90%的区域并注入空气。然后确定每次注射的BB形成成功率。
成功形成完整BB的平均针深度为79.9%±3.0%,部分BB形成的平均针深度为66.9%±2.6%,未形成BB的平均针深度为49.9%±3.4%(P<0.0001)。以针尖下方的基质表示,成功形成完整BB对应的深度为123.9±20.0μm,部分BB形成对应的深度为233.7±23.8μm,未形成BB对应的深度为316.7±17.3μm(P<0.0001)。测试的所有其他变量(性别、种族、年龄、内皮细胞密度、注入空气量、针角度和中央角膜厚度)均未显著影响BB形成成功率。
如果在更深的角膜深度进行针插入和空气注入,DALK中的BB形成更成功。然而,在这个DALK离体模型中,角膜深度≥90%并非必要条件。SS-MIOCT可用于实时准确引导针。