Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment

Continuous intraoperative optical coherence tomography (iOCT) integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet’s membrane detachment (DMD) following deep anterior lamellar keratoplasty (DALK) with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the change in height of the detached Descemet’s membrane (DM). Additionally stab incisions were given through the anterior cornea due to the presence of residual fluid above the DM which was visible on continuous iOCT images. This led to the successful apposition of the DM which otherwise would have remained detached due to the residual fluid. This highlights the importance of continuous iOCT monitoring of the ophthalmic surgical procedures in order to produce a successful anatomical outcome of the surgery without disruption of the surgical procedure.