1. Articles from Jeewan S. Titiyal

    1-13 of 13
    1. Intraoperative Optical Coherence Tomography in Anterior Segment Surgery

      Intraoperative Optical Coherence Tomography in Anterior Segment Surgery

      Intraoperative optical coherence tomography (iOCT) enables real-time visualization of ocular structures during surgery and enhances our understanding of intraoperative dynamics. iOCT aids in decision making during various anterior segment surgeries, and its efficacy and feasibility in anterior lamellar keratoplasty and endothelial keratoplasty is well established. The landmark DISCOVER study observed that iOCT altered the surgeon decision in 38% of cases undergoing lamellar keratoplasty and provided guidance regarding the need for secondary surgical intervention. iOCT also finds an application in phacoemulsification wherein it helps to assess corneal incisions, intralenticular pressure, and posterior capsule integrity during nuclear emulsification. iOCT aids in the ...

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    2. Elucidating Intraoperative Dynamics and Safety in Posterior Polar Cataract with iOCT Guided Phacoemulsification

      Elucidating Intraoperative Dynamics and Safety in Posterior Polar Cataract with iOCT Guided Phacoemulsification

      Purpose: To evaluate morphological characteristics and intraoperative dynamics of posterior polar cataract (PPC) using intraoperative optical coherence tomography (iOCT) Setting: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Design: Prospective interventional study Methods: Forty eyes with PPC undergoing phacoemulsification were evaluated. Primary outcome measure was morphology of PPC and intraoperative dynamics of posterior capsule. Secondary outcome measure was PC rent, which was retrospectively compared with 72 PPC cases that underwent non-iOCT guided surgery. Results: Three morphological variants of PPC were observed- Type I (47.5%, 19/40) characterized by intact PC and clearance ...

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    3. Evaluation of the signs of deficient posterior capsule in posterior polar cataracts using anterior segment optical coherence tomography

      Evaluation of the signs of deficient posterior capsule in posterior polar cataracts using anterior segment optical coherence tomography

      Purpose: To systematically observe and analyze the signs of deficient posterior capsule in posterior polar cataracts. Design: Ambispective observational study. Participants: Cases with posterior polar cataracts. Methods: Eyes with diagnosed posterior polar cataracts were imaged on anterior segment optical coherence tomography. A detailed assessment was performed to note the morphology of the posterior opacity, posterior capsule, and the common patterns to indicate their abnormality. In addition, generalized observation of the morphology was also performed with respect to intraoperative surgical experiences. Results: A total of 101 eyes were included. The average patient age was 52.85 ± 10.72 years. The posterior ...

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    4. Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization

      Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization

      Purpose: To assess the utility of microscope-integrated intraoperative optical coherence tomography (Mi-OCT) for performing Descemet membrane endothelial keratoplasty (DMEK) in corneas with poor visualization. Methods: It is a prospective interventional case series that included 25 consecutive cases of corneal decompensation with poor visualization that underwent Mi-OCT-guided DMEK at a tertiary eye care centre. The main outcome measures were graft attachment on day 3 and requirement for re-bubbling. Results: The etiology for corneal decompensation was pseudophakic bullous keratopathy (n=17), Fuchs endothelial corneal dystrophy (n=4), failed graft (n=2), iridocorneal endothelial syndrome (n=1) and failed Descemet stripping automated endothelial ...

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    5. Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema

      Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema

      Purpose: To describe the outcome of microscope integrated optical coherence tomography (MiOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of the crystalline lens and corneal edema. Methods: MiOCT-guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal edema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MiOCT. Results: In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication ...

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    6. Spontaneous anterior dislocation of lens in a case of ectopia lentis et pupillae: a rare entity treated by a novel technique of microscope integrated optical coherence tomography (MIOCT) guided intralenticular lens aspiration

      Spontaneous anterior dislocation of lens in a case of ectopia lentis et pupillae: a rare entity treated by a novel technique of microscope integrated optical coherence tomography (MIOCT) guided intralenticular lens aspiration

      A 7-year-old girl presented with watering and redness in the left eye for 2 months. Her parents reported poor vision in both eyes for 4 years. Visual acuity was finger counting at 1 m and finger counting close to face in the right and left eyes, respectively. Slit lamp examination of the right eye revealed corectopia, aphakia in the pupillary area, temporally subluxated clear crystalline lens, persistent pupillary membrane, irido-hyaloidal adhesion and poorly dilating pupil. Left eye revealed central corneal oedema with descemet scarring, anteriorly dislocated clear crystalline lens with lenticulo-corneal touch. Ultrasound examination of the left eye was normal ...

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    7. Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis

      Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis

      Purpose: To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis . Methods: Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated. Results: Mean CT and IT at presentation were 650.5 ± 108 μm and 401.1 ± 91 μm, which reduced significantly at each follow-up [on days 7, 14, 28, and 42 ...

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    8. Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation

      Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation

      Purpose: The aim of this study is to describe a modified surgical technique of continuous intraoperative optical coherence tomography (iOCT)-guided shield ulcer debridement with tuck-in multilayered Amniotic membrane transplantation (ML AMT) in vernal keratoconjunctivitis (VKC) with shield ulcer with plaque. Methods: Seven eyes of seven patients presenting with VKC with shield ulcer with plaque were enrolled in this prospective case series and planned for shield ulcer debridement with ML AMT. Debridement of the ulcer base with double-layered AMT was done under the continuous guidance of iOCT. The main outcome measure was the time for complete reepithelialization. Statistical analysis was ...

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    9. Intraoperative Optical Coherence Tomography–Guided Management of Cap–Lenticule Adhesion During SMILE

      Intraoperative Optical Coherence Tomography–Guided Management of Cap–Lenticule Adhesion During SMILE

      PURPOSE: To report successful lenticule extraction using intraoperative optical coherence tomography (OCT) in a case of cap–lenticule adhesion during small incision lenticule extraction (SMILE). METHODS: Case report. RESULTS: A 22-year-old patient with a refractive error of −5.00 −0.50 × 120° and −5.00 −0.75 × 60° in the right and left eyes, respectively, was scheduled for SMILE. The lenticule was created using the VisuMax femtosecond laser system (Carl Zeiss Meditec, Jena, Germany). The surgeon experienced difficulty while extracting the lenticule in the right eye. The patient was immediately shifted under the surgical microscope integrated with intraoperative OCT. The ...

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    10. Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique

      Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique

      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 ...

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    11. AS-OCT as a Rescue Tool During Difficult Lenticule Extraction in SMILE

      AS-OCT as a Rescue Tool During Difficult Lenticule Extraction in SMILE

      PURPOSE: To report a case of lenticule adherent to the anterior cap during small incision lenticule extraction (SMILE) and its subsequent management aided by anterior segment optical coherence tomography (AS-OCT). METHODS: Case report. RESULTS: A 24-year-old woman presented with high myopia of −8.00 −0.50 @ 180° in the right eye and −8.00 −0.25 @ 180° in the left eye and underwent SMILE. In the right eye, difficulty was experienced in separating the lenticule from adjacent stroma. AS-OCT examination confirmed the presence of the lenticule adherent to the anterior stromal cap with the plane of dissection visible posterior to ...

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    12. Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment

      Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment

      Continuous intraoperative optical coherence tomography (iOCT) integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet’s membrane detachment (DMD) following deep anterior lamellar keratoplasty (DALK) with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the ...

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    13. Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty

      Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty

      Purpose: To evaluate the time to donor lenticule apposition in cases of Descemet stripping automated endothelial keratoplasty (DSAEK) using microscope-integrated intraoperative optical coherence tomography (iOCT). Methods: Thirty eyes of 27 patients planned to undergo Descemet stripping automated endothelial keratoplasty were enrolled in this prospective study. In group I (n = 10), continuous intracameral positive pressure was maintained for 8 minutes. In group II (n = 10) and group III (n = 10), external corneal massage was initiated simultaneously with positive intracameral air pressure. The external corneal massage was continued till complete resolution of interface fluid; the positive intracameral pressure was maintained for 8 ...

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    1-13 of 13
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    Evaluation of Time to Donor Lenticule Apposition Using Intraoperative Optical Coherence Tomography in Descemet Stripping Automated Endothelial Keratoplasty Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet’s membrane detachment AS-OCT as a Rescue Tool During Difficult Lenticule Extraction in SMILE Microscope-integrated intraoperative optical coherence tomography-guided small-incision lenticule extraction: New surgical technique Intraoperative Optical Coherence Tomography–Guided Management of Cap–Lenticule Adhesion During SMILE Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis Spontaneous anterior dislocation of lens in a case of ectopia lentis et pupillae: a rare entity treated by a novel technique of microscope integrated optical coherence tomography (MIOCT) guided intralenticular lens aspiration Microscope Integrated Intraoperative Optical Coherence Tomography-Guided DMEK in Corneas with Poor Visualization Evaluation of the signs of deficient posterior capsule in posterior polar cataracts using anterior segment optical coherence tomography Optical Coherence Tomography: Critical Tool to Manage Expectations after Cataract Extraction Improving the characterization of ex vivo human brain optical properties using high numerical aperture optical coherence tomography by spatially constraining the confocal parameters