Ocular Perforation and Trauma Surgery

Anderson, David

July 04, 2023

Ocular Perforation and Trauma Surgery

How intraoperative OCT supports assessment & repair in ocular trauma management

Corneal perforation with iris plugging shown on the intraoperative OCT. Images provided by Mr. David Anderson Corneal_perforation_with_iris_plugging_teaser.jpg

Ocular traumas and perforating injuries can result in severe vision loss or loss of the eye [1]. This includes corneal perforations which can be challenging to manage, even for seasoned experts. There are many ocular trauma treatment options, and a personalized approach is key to successful management [2]. Ocular trauma can also cause corneal epithelial defects [3].

Intraoperative Optical Coherence Tomography supports ocular trauma and perforation procedures, helping to assess the anatomy and extent of the damage, and aiding in repair.

Discover two ocular trauma and perforation clinical cases shared by Mr. David Anderson, from the University Hospital Southampton in the U.K.

About the author

About Mr. David Anderson

David Anderson is a Consultant Ophthalmic Surgeon and a cornea, cataract and refractive surgery specialist. He has jointly led the corneal fellowship program at Southampton for more than a decade teaching lamellar corneal transplant and anterior segment surgery and has a special interest in refractive surgery including SMILE and topography-guided laser vision correction.

https://www.andersoneyecare.co.uk/

Clinical Case 1: Corneal Perforation with Iris Plugging

Intraoperative Optical Coherence Tomography is a valuable tool in cases of corneal perforation with iris plugging, treated with corneal glue. In this case, there was a full thickness corneal perforation. This can be difficult to see when looking directly at the cornea through the operating microscope. Intraoperative Optical Coherence Tomography helps assess the depth of the perforation.

The first gluing of the perforation looked perfectly satisfactory in the microscope view. The perforation appeared sealed although aqueous was leaking out, but the intraoperative Optical Coherence Tomography showed a big gap between the little disc and the perforation itself. As such, the surgeon concluded the glue wouldn’t hold and effectively close the gap.

Clinically, the surgery could have stopped at this point. Based on the additional intraoperative Optical Coherence Tomography view, the surgeon took the patch off and re-glued it to achieve an optimal post-operative seal.

Figure 1: The intraoperative OCT allowed to assess the extent of the corneal perforation, which was very deep. Images provided by Mr. David Anderson.

Figure 2: After the first gluing of the perforation, the intraoperative OCT revealed a big gap between the little disc and the perforation itself. Images provided by Mr. David Anderson.

Clinical Case 2: Epithelial Surgery: Superficial Keratectomy

In Bowman Layer (BL) Transplant or epithelial surgery, intraoperative Optical Coherence Tomography supports visualization of the anterior layers of the cornea aiding superficial keratectomy surgery of the epithelium and BL. In this case, the anatomy can be visualized clearly, showing the scrolls of epithelium leaving the basement membrane beneath.

Figure 3: The intraoperative OCT showed the scrolls of epithelium leaving the basement membrane. Images provided by Mr. David Anderson.

Please note that off-label uses of products may be discussed. Please check with regulatory affairs for cleared indications for use in your region. The statements of the healthcare professionals included in this clinical case reflect only their opinion and personal experience and not those of Leica Microsystems. They also do not necessarily reflect the opinion of any institution with whom they are affiliated.

References

Ocular Penetrating and Perforating Injuries, EyeWiki, American Academy of Ophthalmology, Accessed on December 15th 2022 at https://eyewiki.aao.org/Ocular_Penetrating_and_Perforating_Injuries
Corneal Perforations, EyeNet Magazine, American Academy of Ophthalmology, Accessed on December 15th 2022 at https://www.aao.org/eyenet/article/corneal-perforations
Corneal Epithelial Defect, EyeWiki, American Academy of Ophthalmology, Accessed on December 15th 2022 at https://eyewiki.aao.org/Corneal_Epithelial_Defect