Sharma Namrata, Priyadarshini K, Agarwal Rinky, Bafna Rahul Kumar, Nagpal Ritu, Sinha Rajesh, Agarwal Tushar, Maharana Prafulla Kumar, Titiyal Jeewan Singh
Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Dehli, India.
Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Dehli, India.
Am J Ophthalmol. 2021 Jan;221:190-198. doi: 10.1016/j.ajo.2020.07.048. Epub 2020 Aug 7.
We evaluate the role of microscope-integrated intraoperative optical coherence tomography (i-OCT) in pediatric keratoplasty.
Combined prospective and retrospective, comparative, interventional study conducted at the Dr Rajendra Prasad Center for Ophthalmic Sciences in New Dehli, India.
Seventy-five children ≤16 years of age undergoing planned keratoplasty were divided into 2 groups and compared regarding intraoperative course and postoperative outcome. In group 1 (prospective group, n = 56), preoperative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In group 2 (retrospective group, n = 19), a conventional microscope was used during keratoplasty.
In group 1, i-OCT, UBM, and clinical examination detected retrocorneal membrane in 10%, 7.5%, and 5% (P = .005), iris adhesions in 62.5%, 57.5%, and 20% (P = .02), iris stump in aniridia 15%, 10%, and 0% (P = .001), shallow central anterior chamber in 22.5%, 22.5%, and 7.5% (P = .003), and shallow peripheral anterior chamber in 65%, 60%, and 17.5% (P = .004) of children, respectively. The use of i-OCT affected intraoperative surgeon decision making in 45% and 33% of cases of anterior and posterior lamellar keratoplasty, respectively. During penetrating keratoplasty, concomitant intraoperative procedures were higher in group 1 than in group 2, namely synechiolysis (19/40 vs 2/15; P = .1), pupilloplasty (4/40 vs 0/15; P = .02), lens extraction (4/40 vs 1/15; P = .5), and anterior vitrectomy (2/40 vs 1/15; P = .4). Postoperative secondary interventions were lower (P = .04) in group 1 (48.21% vs 94.74%).
Anterior segment imaging with i-OCT and UBM immediately before surgery improves the surgical planning of children with corneal opacities. In addition, the use of i-OCT refines intraoperative steps, thereby optimizing the postoperative outcome of pediatric keratoplasty.
我们评估显微镜集成术中光学相干断层扫描（i - OCT）在小儿角膜移植术中的作用。
在印度新德里的拉金德拉·普拉萨德眼科科学中心进行的前瞻性与回顾性相结合的比较性干预研究。
75名年龄≤16岁计划接受角膜移植术的儿童被分为两组，比较术中过程和术后结果。在第1组（前瞻性组，n = 56）中，术前通过临床检查、超声生物显微镜（UBM）和i - OCT进行眼前节可视化，并在i - OCT显微镜下开始角膜移植术。在第2组（回顾性组，n = 19）中，角膜移植术中使用传统显微镜。
在第1组中，i - OCT、UBM和临床检查分别在10%、7.5%和5%的儿童中检测到角膜后膜（P = 0.005），虹膜粘连在62.5%、57.5%和20%的儿童中被检测到（P = 0.02），无虹膜症中的虹膜残端在15%、10%和0%的儿童中被检测到（P = 0.001），中央前房浅在22.5%、22.5%和7.5%的儿童中被检测到（P = 0.003），周边前房浅在65%、60%和1 / 7.5%的儿童中被检测到（P = 0.004）。i - OCT的使用分别在45%的前板层角膜移植术和33%的后板层角膜移植术病例中影响了术中外科医生的决策。在穿透性角膜移植术中，第1组的术中伴随操作高于第2组，即虹膜粘连分离术（19 / 40对2 / 15；P = 0.1）、瞳孔成形术（4 / 40对0 / 15；P = 0.02）、晶状体摘除术（4 / 40对1 / 15；P = 0.5）和前部玻璃体切除术（2 / 40对1 / 15；P = 0.4）。第1组的术后二次干预较低（P = 0.04）（48.21%对94.74%）。
术前立即使用i - OCT和UBM进行眼前节成像可改善角膜混浊儿童的手术规划。此外，i - OCT的使用优化了术中步骤，从而优化了小儿角膜移植术的术后结果。
