Intraoperative optische Kohärenztomografie bei der tiefen anterioren lamellären Keratoplastik

 

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Zusammenfassung

Hintergrund: Die tiefe anteriore lamelläre Keratoplastik (DALK) ist neben der perforierenden Keratoplastik eine Standardtherapie beim Keratokonus und stromalen Hornhautdystrophien. Die intraoperative OCT-Technologie (iOCT) ermöglicht ein Operationsmonitoring in Echtzeit, insbesondere dann, wenn Distanzen geschätzt werden müssen oder der Einblick in die Augenvorderkammer eingeschränkt ist. Methoden: Literaturübersicht aus PubMed und eigene klinische und experimentelle Daten. Als Suchabfrage wurden die Stichworte „intraoperative Optical Coherence Tomography“, „DALK“, „Deep anterior lamellar keratoplasty“ und „iOCT“ genutzt. Als Zeitraum wurde 2005–2016 gesetzt. Ergebnisse: Mittels intraoperativer OCT-Technologie lassen sich alle Operationsschritte der DALK visualisieren. Die intraoperative OCT hilft vor allen Dingen bei der Tiefenabschätzung der Nadelplatzierung und reduziert die Interface-Flüssigkeit. Schlussfolgerung: Die intraoperative OCT-Technologie hilft, die DALK-Chirurgie zu standardisieren. Zukünftige prospektive Studien müssen zeigen, ob die OCT-geführte DALK sicherer ist als die DALK ohne intraoperative OCT und bessere Ergebnisse liefert.

Abstract

Background: Like penetrating keratoplasty (pKPL), deep anterior lamellar keratoplasty (DALK) is a standard treatment for keratoconus and stromal corneal dystrophies. Intraoperative optical coherence tomography permits live or real-time monitoring during surgery, especially if it is necessary to estimate distances or if the anterior chamber view is limited. Methods: Review of literature from PUBMED and our own clinical and experimental data. Key words were “intraoperative Optical Coherence Tomograph”, “DALK”, “Deep anterior lamellar keratoplasty” and “iOCT”. The time frame was set from 2005 to 2016. Results: All surgical steps were visualisable by intraoperative OCT during DALK surgery. Intraoperative OCT permits depth estimation during deep needle insertion and allows the visualisation of intraoperative interface fluid. Conclusion: Intraoperative OCT facilitates standardisation during several steps of DALK. Future prospective studies should concentrate on the safety profile of intraoperative OCT-guided DALK compared to DALK without intraoperative monitoring.

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