No abstract

We describe the surgical technique of microscope-integrated intraoperative optical coherence tomography (OCT)-guided small-incision lenticule extraction. The technique enables manual tracking of surgical instruments and identification of the desired dissection plane. It also helps discern the relation between the dissector and the intrastromal lenticule. The dissection plane becomes hyperreflective on dissection, ensuring complete separation of the intrastromal lenticule from the overlying and underlying stroma. Inadvertent posterior plane entry, cap-lenticule adhesion, incomplete separation of the lenticule, creation of a false plane, and lenticule remnants may be recognized intraoperatively so corrective steps can be taken immediately. In cases with a hazy overlying cap, microscope-integrated intraoperative OCT enables localization and extraction of the lenticule. The technique is helpful for inexperienced surgeons, especially in cases with low amplitudes of refractive errors, ie, thin lenticules.

Intraoperative OCT is useful in cases of difficult lenticule extraction during SMILE because it provides real-time visualization of the lenticule and helps in discerning its relation with the anterior stromal cap and the underlying stromal bed. By using intraoperative OCT and the continuous curvilinear lenticulerrhexis technique, satisfactory anatomical and visual outcomes were obtained. [J Refract Surg. 2017;33(11):783-786.].

Optimal visual recovery following full-thickness traumatic wound dehiscence in a case of operated deep anterior lamellar keratoplasty (DALK) is rarely seen. Here we report a case of 22-year-old male patient presented to our casualty department with complaint of sudden-onset diminution of vision in his right eye following blunt trauma of 1 day duration. DALK had been performed 11 months ago for advanced keratoconus in the same eye. Best-corrected visual acuity (BCVA) in the right eye was hand movement close to face with accurate projection of rays and in the left eye was 20/20. Slit-lamp examination showed the presence of inferior 180° graft dehiscence with broken sutures and shallow anterior chamber with corneal oedema. Repair of the dehiscence with descemetopexy was done under the guidance of intraoperative optical coherence tomography with the successful rescuing of the host Descemet's membrane. BCVA at 6 months follow-up was 20/40.

Surgical skill enhancement for the residents under training can be performed through various efforts. Here in this report, the authors describe a technique of corneoscleral perforation repair on goat's eye, as the tissue resemblance and the reality of experience while performing crucial steps are similar to human eyes. Beginning from tissue handling, optimal suture placement was taught with an intention to impart quality techniques of traumatic globe injury repair. Therefore, rather than training on expensive artificial eye model, training budding surgeons on goat's eye gives much more realistic tissue handling experiences in the presence of constant challenges almost similar to human eyes.