Siebelmann Sebastian, Matthaei Mario, Heindl Ludwig M, Bachmann Björn O, Cursiefen Claus
Zentrum für Augenheilkunde, Universitätsklinikum Köln.
Klin Monbl Augenheilkd. 2018 Jun;235(6):714-720. doi: 10.1055/a-0587-5374. Epub 2018 Jun 12.
The surgical treatment of corneal dystrophies develops rapidly as the use of lamellar corneal grafting techniques continue. While penetrating keratoplasty was the gold standard for treating a variety of dystrophies a few years ago, the affected layers of the cornea can, nowadays, be selectively replaced or ablated using laser technology. Of particular importance for these methods is optical coherence tomography, which has recently been integrated into surgical microscopes (MI-OCT).
Literature overview from PubMed and Google.scholar.de supplemented with own imaging data.
The MI-OCT enables the intraoperative real-time monitoring of different ophthalmic surgical procedures, such as deep anterior lamellar keratoplasty, Descemet's membrane endothelial keratoplasty, as well as minimally-invasive procedures, such as phototherapeutic keratectomy. In addition, it enables an evaluation of the cornea, but also of structures of the anterior chamber, in situations in which the cornea, for example, is clouded by an edema.
Microscope-integrated, intraoperative optical coherence tomography (MI-OCT) represents a useful supplement to the normal surgical microscope. It is superior to the sole surgical microscope, especially in already severely clouded corneas, and represents a sensible supplement, especially for novel lamellar transplantation procedures. Prospective randomized trials are necessary to increase safety and efficacy when using MI-OCT for different indications.
随着板层角膜移植技术的不断应用，角膜营养不良的外科治疗发展迅速。几年前，穿透性角膜移植术是治疗各种角膜营养不良的金标准，而如今，可使用激光技术选择性地替换或消融角膜的病变层。对于这些方法而言，光学相干断层扫描尤为重要，该技术最近已被整合到手术显微镜中（显微镜集成光学相干断层扫描，MI-OCT）。
通过PubMed和Google.scholar.de进行文献综述，并补充自己的成像数据。
MI-OCT能够在术中对不同的眼科手术进行实时监测，如深板层角膜移植术、Descemet膜内皮角膜移植术，以及微创操作，如光治疗性角膜切削术。此外，在角膜例如因水肿而混浊的情况下，它不仅能够评估角膜，还能评估前房结构。
显微镜集成的术中光学相干断层扫描（MI-OCT）是对常规手术显微镜的有益补充。它优于单纯的手术显微镜，尤其是在角膜已经严重混浊的情况下，并且是一种合理的补充，特别是对于新型板层移植手术。为了提高MI-OCT用于不同适应症时的安全性和有效性，有必要进行前瞻性随机试验。
