PURPOSE: Cultivated limbal epithelial stem cell transplantation (CLET) is a surgical approach reserved for severe stem cell deficiency and anterior segment pathology. The recipient cornea typically displays a highly vascularized pannus that must be dissected before graft placement. Extensive pannus dissection, however, can result in corneal thinning and increase the risk of ectasia and ultimately, of perforation. We aimed to examine the value of anterior segment optical coherence tomography (AS-OCT) intraoperatively during pannus resection and long-term postoperative follow-up of CLET surgery. DESIGN: This was a prospective observational case series. METHODS: This study was performed on 8 eyes of 8 patients who underwent CLET surgery. Intraoperative OCT was performed before dissection and at several time points during dissection and after placement of the ex vivo cultivated graft. During the postoperative follow-up period, OCT was performed to image the graft integration and corneal thickness. RESULTS: Anterior segment optical coherence tomography provided high-resolution images of the corneal pannus, including the blood vessel lumen. Imaging of the pannus depth and cleavage plane was possible intraoperatively, with the patient supine. Postoperative imaging displayed the transplanted graft, temporary amniotic membrane patch, and overlying bandage contact lens. The grafts were also visible after removal of the temporary membrane patch. Four months postoperatively, the grafts were integrated into the cornea, and all 8 participants showed the presence of an epithelial layer. CONCLUSIONS: During CLET surgery, AS-OCT offers a noncontact method for rapid, intraoperative scanning and pachymetry mapping. Intraoperative OCT guidance assists in the removal of the delicate fibrovascular pannus. Sparing the viable corneal stroma can reduce the risk of extreme thinning, iatrogenic ectasia, and wound dehiscence while providing a smooth recipient surface for the composite graft.
PURPOSE: Cultivated limbal epithelial stem cell transplantation (CLET) is a surgical approach reserved for severe stem cell deficiency and anterior segment pathology. The recipient cornea typically displays a highly vascularized pannus that must be dissected before graft placement. Extensive pannus dissection, however, can result in corneal thinning and increase the risk of ectasia and ultimately, of perforation. We aimed to examine the value of anterior segment optical coherence tomography (AS-OCT) intraoperatively during pannus resection and long-term postoperative follow-up of CLET surgery. DESIGN: This was a prospective observational case series. METHODS: This study was performed on 8 eyes of 8 patients who underwent CLET surgery. Intraoperative OCT was performed before dissection and at several time points during dissection and after placement of the ex vivo cultivated graft. During the postoperative follow-up period, OCT was performed to image the graft integration and corneal thickness. RESULTS: Anterior segment optical coherence tomography provided high-resolution images of the corneal pannus, including the blood vessel lumen. Imaging of the pannus depth and cleavage plane was possible intraoperatively, with the patient supine. Postoperative imaging displayed the transplanted graft, temporary amniotic membrane patch, and overlying bandage contact lens. The grafts were also visible after removal of the temporary membrane patch. Four months postoperatively, the grafts were integrated into the cornea, and all 8 participants showed the presence of an epithelial layer. CONCLUSIONS: During CLET surgery, AS-OCT offers a noncontact method for rapid, intraoperative scanning and pachymetry mapping. Intraoperative OCT guidance assists in the removal of the delicate fibrovascular pannus. Sparing the viable corneal stroma can reduce the risk of extreme thinning, iatrogenic ectasia, and wound dehiscence while providing a smooth recipient surface for the composite graft.
Authors: Sophie X Deng; Vincent Borderie; Clara C Chan; Reza Dana; Francisco C Figueiredo; José A P Gomes; Graziella Pellegrini; Shigeto Shimmura; Friedrich E Kruse Journal: Cornea Date: 2019-03 Impact factor: 2.651