Lin Charles C, Lee Wen-Shin
Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA.
Taiwan J Ophthalmol. 2023 Feb 21;13(1):106-109. doi: 10.4103/tjo.TJO-D-22-00151. eCollection 2023 Jan-Mar.
Gauging stromal dissection depth is crucial to successfully perform deep anterior lamellar keratoplasty (DALK) surgery. Intraoperative optical coherence tomography (iOCT) offers a promising tool to aid DALK surgery but visualization of surgical maneuvers is impaired due to artifacts from metallic instruments. We describe a novel surgical technique utilizing suture-assisted iOCT guidance that facilitates clear visualization of corneal dissection planes during DALK. A stromal dissection tunnel is performed with a Fogla probe and its depth is subsequently identified by threading a 1 cm segment of 8-0 nylon into the tunnel. In contrast to the Fogla probe, the 8-0 nylon is conspicuously highlighted on iOCT. If the tunnel is too superficial, a separate, deeper stromal tunnel can be created and visualized again with the 8-0 nylon suture and iOCT. This iterative process facilitates a deep stromal dissection, increasing the probability of successful big-bubble formation and Descemet baring DALK surgery. This technique was utilized for a successful big-bubble DALK in a patient with severe keratoconus.
测量基质剥离深度对于成功进行深板层角膜移植术（DALK）至关重要。术中光学相干断层扫描（iOCT）为辅助DALK手术提供了一种很有前景的工具，但由于金属器械产生的伪像，手术操作的可视化受到影响。我们描述了一种利用缝线辅助iOCT引导的新型手术技术，该技术有助于在DALK手术期间清晰地可视化角膜剥离平面。用Fogla探针制作一个基质剥离隧道，随后通过将一段1厘米长的8-0尼龙线穿入隧道来确定其深度。与Fogla探针不同，8-0尼龙线在iOCT上显著突出显示。如果隧道太浅，可以创建一个单独的、更深的基质隧道，并用8-0尼龙缝线和iOCT再次进行可视化。这个迭代过程有助于进行深层基质剥离，增加成功形成大泡和暴露后弹力层的DALK手术的概率。该技术用于一名患有严重圆锥角膜患者的成功大泡DALK手术。
