Intraoperative assessment of corneal injuries using microscope-integrated optical coherence tomography.

A 2-year-old male child presented to the ocular emergency following penetrating injury with a metallic foreign body. Clinical examination revealed a nasal corneal perforation with iris tissue prolapse [Fig. 1, yellow arrow]. To further delineate the extent of the corneal perforation and associated anterior segment changes, integrated optical coherence tomography (iOCT) was used. It showed corneal wound gaping for entire corneal thickness from the paracentral region to the periphery of the cornea. Within the gaping, prolapsing hyperreflective tissue was made out in continuity with the iris tissue onto the surface of the epithelium, suggestive of iris tissue [Fig. 2a]. The margins from endothelium to the epithelium were regular without any tissue corneal tissue loss. Along the center and periphery of the cornea, the corneal gaping becomes prominent [Fig. 2b].

Figure 1

Microscopic examination of the injured eye showing nasal corneal perforation with iris tissue prolapse

Figure 2

(a) The iOCT images along the right aspect (upper panel) showing vertical corneal wound gaping with associated iris tissue prolapse. (b) At the center the wound gaping was more evident with iris tissue prolapse. However, there was no any corneal tissue loss. (c) Following corneal perforation repair, the margins were well opposed with minimal pigmentary residuals along the margins. (d) The suture tracts could be made out roughly along the 50–75% depth of the corneal stroma and the iris tissue was in its anatomical position in absence of any endothelial contact

Following surgery, the iOCT increased corneal thickness due to stromal edema with well-opposed margins [Fig. 2c and d]. The endothelium on either side of the wound showed a good continuity. Similarly, the stroma and the epithelium showed perfect opposition without any intervening residual iris tissue or any tissue loss.

Discussion

The iOCT mainly helps in better intraoperative understanding of the corneal wound-related problems and the cataract and its capsular problems.[1] Similarly, the iOCT also helps in identifying the plane of corneal dissection.[2] This observation mainly highlights the utility of iOCT as an adjunctive tool for corneal injuries assessment intraoperatively.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.