Corneal Ttransplantation Planning Using Anterior Ssegment Oct.

We aim to present the utility of anterior segment optical coherence tomography (AS-OCT) scans as a method for selecting trephine diameter for corneal graft preparation in the pre-operative stage of keratoplasty. 

Cornea clinic in the setting of Galili Medical Center (hospital)

Starting 2021 we performed high-resolution swept-source OCT scans of the anterior segment pre-operatively on keratoplasty candidates using the ANTERION® platform (Heidelberg Engineering GmbH, Heidelberg, Germany). In these scans measurements of the estimated corneal graft diameter were taken using the ANTERION® Metrics application provided with the platform. 

Fifty eyes were scanned pre-operatively using the ANTERION® Metrics application for graft size estimation and trephine diameter selection. Scans were performed on candidates for penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), Descemet’s membrane endothelial keratoplasty (DMEK) and repeated keratoplasty. We scanned phakic and pseudophakic eyes, including eyes with anterior chamber intra-ocular lens (ACIOL), eyes with previous glaucoma surgery and eyes with past penetrating trauma.

Based on our experience, AS-OCT imaging is an effective and elegant tool that can be used by the surgeon pre-operatively for optimal corneal graft size estimation, selection of trephine diameter and evaluation of individual anterior chamber anatomy while taking under consideration the patient’s previous ocular history. Moreover, it is our view that this method is superior in terms of minimizing graft size errors to other graft size evaluation techniques such as horizontal white to white (hWTW). Finally, this method enables the preparation of a personally fitted corneal graft in advance, hence allowing the surgeon to skip the intra-operative caliper measurements and graft preparation steps and thus decreasing overall surgery time.