COMMENTARY

Advances in Anterior Segment OCT

European Society of Cataract & Refractive Surgeons (ESCRS) 2013

Roger F. Steinert, MD

Disclosures

October 31, 2013

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Hi. I am Roger Steinert, Chair of Ophthalmology at the University of California, Irvine, and Director of the Gavin Herbert Eye Institute.

I am in Amsterdam at the European Society of Cataract & Refractive Surgeons (ESCRS) meeting. Today I heard 3 interesting presentations, all related to anterior segment optical coherence tomography (OCT). We are continuing to explore ways to use this technology to our benefit.

One of the presentations[1] was on using OCT postoperatively to follow corneal transplants, both full-thickness and partial-thickness grafts, to try to anticipate early signs of rejection. I wasn't entirely convinced that this would work, but it's certainly an interesting concept.

The second presentation[2] was on using OCT to monitor the reaction of the cornea to collagen cross-linking, particularly for keratoconus, as well as other conditions, such as LASIK ectasia. The basic idea is that there is increased signal return with cross-linking, so you can quantitatively get some measure of the success of your treatment. It is also potentially useful as a way of evaluating some of the different collagen cross-linking techniques that are being proposed: epithelium-on, epithelium-off, or partial disruption of the epithelium; different soak times for riboflavin and different carriers for riboflavin that penetrate differently; and different ultraviolet exposure densities and times. All of those variables are in play. No consistent finding was presented. Nevertheless, OCT is one way of trying to get a quantitative measure. I think it was quite interesting.

The third and most novel presentation[3] was about Haag-Streit incorporating anterior segment OCT into the operating microscope. There have been procedures for which we say, "Gee, I really wish I knew what was going on in a true 3-dimensional sense." We haven't been able to do that. They showed some early videos of a DSAEK (Descemet stripping automated endothelial keratoplasty) procedure and a DMEK (Descemet membrane endothelial keratoplasty) procedure, the stripping off of a patient's Descemet membrane and insertion of donor material. It was interesting and showed some detail. It also showed the challenges, because the operative manipulations and movements create quite a bit of artifact with the eye moving around. It looked like the technology was promising, but it is just first-generation. It will be very interesting to see how that evolves.

This is Roger Steinert, reporting from Amsterdam on behalf of Medscape.

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