Intraoperative optical coherence tomography-assisted retrocorneal fibrous membrane biopsy and excision

Abstract

PurposeWe report a case of retrocorneal fibrous membrane (RCFM) formation following penetrating keratoplasty (PK) and intraoperative optical coherence tomography (OCT)-guided excision of this membrane.ObservationsA 68-year-old woman with primary open angle glaucoma and corneal decompensation of the right eye secondary to tube shunt presented for 3-month follow-up of PK. On examination of the right eye, the patient was noted to have a glassy pupillary membrane with traction on the iris. Anterior segment OCT confirmed a membrane connecting the iris to host cornea. The patient underwent biopsy and excision of the membrane assisted by intraoperative OCT. Pathological examination was consistent with Descemet's membrane proliferation. We suspect that this membrane represents retained host's Descemet's membrane following corneal transplantation.ConclusionsThis case highlights the existence of RCFM formation in the context of retained host cornea following PK and the role of intraoperative OCT in management.

Application of Intraoperative Optical Coherence Tomography Technology in Anterior Segment Surgery

“…Intracorneal pathology can also be precisely isolated and located for biopsy using iOCT [49]. Ruland et al [50] showed that iOCT was helpful for the identification and excision of retrocorneal fibrous membranes following PK. In cases of acute corneal hydrops in keratoconus, iOCT facilitated the micropuncture of intrastromal fluid pockets combined with compression sutures and gas tamponade, which resulted in immediate reattachment of DM [33].…”

Intraoperative Optical Coherence Tomography –Available Technologies and Possibilities of Use. A Review

“…Intraoperativní OCT (iOCT) se využívá při operacích na předním i zadním segmentu oka. V předně segmentové chirurgii ho lze použít při celé řadě výkonů, zejména při penetrujících, lamelárních a endoteliálních keratoplastikách [1][2][3][4][5][6][7][8][9][10][11][12], při operacích glaukomu [13], katarakty [1,[14][15][16] a biopsiích tkání [1,[17][18]. V zadně segmentové chirurgii se využívá během pars plana vitrektomie (PPV) k řešení sklivcových a sítnicových patologií.…”

Fibröse retrokorneale und perilentale Membran nach perforierender Keratoplastik

“…Zemba et al [11] haben RCM wie folgt unterteilt: 1) epitheliale, 2) fibröse, 3) inflammatorische, 4) aus verbliebener Empfänger-Descemet-Membran entstehende [8] und 5) aus Transplantat-Descemet-Membran-Ablösung entstehende RCMs.…”