We tested a 1310-nm optical coherence tomograph coupled with a beam splitter on the front lens of an operating microscope for intraoperative, noncontact visualization of anterior segment procedures. This new modification of optical coherence tomography technology allows intraoperative, high-resolution, cross-sectional imaging and pachymetry of the cornea and sclera during anterior segment surgery. It is particularly helpful for lamellar dissection techniques such as deep anterior lamellar keratoplasty and trabeculectomy.
Deep anterior lamellar keratoplasty; directing the optical coherence tomography (OCT) beam perpendicular to the corneoscleral surface. A, The OCT view shows a pocket knife in the peripheral sclerocorneal tunnel causing reflection in front of and shadowing behind the instrument. The large arrow shows the position of the sharp tip of the instrument in the dissection plane. B, The OCT view shows lamellar separation in the central cornea with a blunt dissection instrument. Any signals from within the metal instrument are ghost images due to background noise. C, The interface after deep lamellar dissection prior to the injection of a viscoelastic substance. AL indicates anterior lamella; Epi, epithelium; LI, lamellar interface; LS, lamellar separator; and PL, posterior lamella (1310 nm, 100 Hz, 200 scans, 10.0 × 2.03 mm).
Trabeculectomy. Unscaled optical coherence tomography (OCT) images and representative line drawings. A, An OCT beam positioned perpendicularly to the corneoscleral surface, showing the sclerocorneal border. B, In the beginning, the anterior chamber angle is not fully visible. Only at the end of the procedure is it completely visible (C) when a filtering bleb is beginning to form. AC indicates anterior chamber; C, cornea; FB, filtering bleb; PE, pigment epithelium of iris; and S, sclera (1310 nm, 100 Hz, 200 scans, 10 × 2.03 mm).
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