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Purpose

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Purpose

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  1. Analysis of Clear Corneal Incision Architecture with Anterior Segment Spectral-Domain OCTTheodore Leng, MD, Jianhua Wang, MD, PhD, Sonia H. Yoo, MD, Brandon Lujan, MD, Aizhu Tao, MD,GavriilTsechpenakis, PhDBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL USAThe authors have no financial disclosures. This presentation discusses the use of an experimental medical device that has not yet been approved by the FDA.

  2. Purpose To use a prototype AS-SDOCT device to image bi- and tri-planar CCIs constructed for phacoemulsification and to reconstruct those wounds in three-dimensional (3D) space Advantages of AS-SDOCT • Higher axial resolution • Faster acquisition speed • Allows for 3D scans • Wound features can be analyzed across the full dimensions of the incision • Ability to reconstruct wound in 3D

  3. Materials and Methods A prototype 1310 nm wavelength AS-SDOCT instrument was constructed and mounted onto a conventional slit lamp for imaging of the anterior segment. The device had an axial resolution of 8 μm and was able to acquire real-time two-dimensional images at 14 frames/second and full 3D datasets in approximately 7 seconds. AS-SDOCT datasets of 100 B-scans, each consisting of 512 A-scans, were acquired from each patient on post-operative day one after uncomplicated cataract extraction by phacoemulsification. Each 3D scan consisted of a 6 x 6 x 3 mm volume of data. The experimental protocol was approved by an institutional review board and all patients underwent an informed consent process and signed a consent form. The Prototype AS-SDOCT Device The device (black box) as seen mounted on a conventional slit lamp

  4. Results En face image of the cornea Please see movie file for 3D manipulation of data B-scan depicting a CCI (arrow)

  5. The incision is traced on individual B-scans to create a surface depiction of the CCI geometry

  6. Data Analysis • Compared surgical technique to actual wound shape on OCT scans • Analyzed wounds for characteristics possibly associated with ingress of fluid and endophthalmitis • 13 “bi-planar” wounds scanned • 10 “tri-planar” wounds scanned Loss of Coaptation • Bi-Planar • 1 of 13 • Tri-Planar • 0 of 10

  7. Geometry Bi-Planar • 3 of 13 (23%) had true bi-planar geometry • Remainder had curvilinear Tri-Planar • 6 of 10 (60%) had true tri-planar geometry • Of the remainder: • Combined Bi and Tri (1) • Pure bi-planar (1) • Curvilinear (2)

  8. Wound Gape • Epithelial Side • 1 of 13 bi-planar • 1 of 10 tri-planar • Endothelial Side • 1 of 13 bi-planar • 5 of 10 tri-planar

  9. Misalignment • Bi-Planar • Epithelial - None • Endothelial - 2 of 13 • Tri-Planar • Epithelial – None • Endothelial – 1 of 10

  10. Stromal Edema • Bi-Planar • 3 of 13 • Greater in Roof - 2 • Greater in Floor - 1 • Tri-Planar • 4 of 10 • Greater in Roof - 3 • Variable throughout width of wound - 1

  11. Descemet’s Detachments • Bi-Planar • 9 of 13 • Tri-Planar • 2 of 10

  12. Conclusions • Tri-planar techniques were likely to result in true tri-planar geometry on AS-SDOCT scans • Tri-planar CCIs had a higher incidence of wound gape than bi-planar CCIs • Neither technique had a high rate of loss of coaptation • Both techniques had an equal rate of misalignment and stromal edema • Bi-planar technique was more likely to result in Descemet’s detachments Future Directions • Improved wound reconstructions • Calculation of wound surface area (which may be related to leakage and rates of endophthalmitis) • Measurement of wound lengths and angles • Decrease image acquisition time to reduce motion artifiact

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