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PHOTO ESSAY
Year : 2018  |  Volume : 66  |  Issue : 11  |  Page : 1614-1615

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


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission15-Apr-2018
Date of Acceptance27-Jun-2018
Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Amar Pujari
Room No. 212, RPC-1 Hostel, AIIMS, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_546_18

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  Abstract 


Keywords: Integrated optical coherence tomography, pediatric corneal injuries, surgery


How to cite this article:
Pujari A, Mukhija R, Urkude J, Singh R, Agarwal D, Sharma N. Intraoperative assessment of corneal injuries using microscope-integrated optical coherence tomography. Indian J Ophthalmol 2018;66:1614-5

How to cite this URL:
Pujari A, Mukhija R, Urkude J, Singh R, Agarwal D, Sharma N. Intraoperative assessment of corneal injuries using microscope-integrated optical coherence tomography. Indian J Ophthalmol [serial online] 2018 [cited 2020 Oct 27];66:1614-5. Available from: https://www.ijo.in/text.asp?2018/66/11/1614/244067



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 [[Figure 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 [Figure 2]a. 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 [Figure 2]b.
Figure 1: Microscopic examination of the injured eye showing nasal corneal perforation with iris tissue prolapse

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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

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Following surgery, the iOCT increased corneal thickness due to stromal edema with well-opposed margins [Figure 2]c and [Figure 2]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 Top


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.



 
  References Top

1.
Titiyal J, Kaur M, Falera R. Intraoperative optical coherence tomography in anterior segment surgeries. Indian J Ophthalmol 2017;65:116.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sharma N, Aron N, Kakkar P, Titiyal JS. Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty Descemet's membrane detachment. Saudi J Ophthalmol 2016;30:133-6.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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