Intraoperative OCT guided corneal sweeping used for removal
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Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK.

All eyes were subjected to iOCT-guided UT-DSAEK in this retrospective analysis. To extract excess fluid, a meticulous corneal sweeping procedure was performed on the periphery. Before surgery, after graft bubbling, and after corneal sweeping, the central graft thickness (CGT) was determined. The rates of residual interface fluid were measured between eyes that were rebubbled and those that were not.

Results:
--Overall, 28 eyes of 28 patients with a mean age of 73.9±10.0 years were included.

--An iOCT guided meticulous peripheral sweeping was performed in 89.3% of the cases.

--Following 84% of the peripheral sweeping performed, remnant fluid was no longer identified.

--Following peripheral sweeping the interface fluid height was reduced from 17.31±15.96 microm to 3.46±9.52 microm and CGT was reduced by 7%.

--Rebubbling was performed in 17.9% of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%).

Finally, in approximately 90% of UT-DSAEK cases, the iOCT revealed subclinical residual fluid. In the majority of cases, an iOCT-guided peripheral corneal sweeping resulted in the resolution of interface fluid. Rebubbling is more likely to be needed in eyes that have residual fluid despite peripheral corneal sweeping.

Source: https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-021-01934-2
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