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Surgical Technique
December 2017

Use of Intraoperative Optical Coherence Tomography for Tube Positioning in Glaucoma Surgery

Author Affiliations
  • 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2017;135(12):1438-1439. doi:10.1001/jamaophthalmol.2017.4431

Intraoperative optical coherence tomography (iOCT) has become a valuable adjunct to ophthalmic surgery in the past decade. Although iOCT has been used extensively in retinal surgery for epiretinal membrane peel and in corneal surgery for lamellar keratoplasty,1-4 its use in surgical procedures for glaucoma remains limited. Dada et al5 describe the use of iOCT in guiding needling of a trabeculectomy bleb, whereas Siebelmann et al6 introduced the use of iOCT in canaloplasty. To our knowledge, the utility of iOCT has not been assessed in implantation of glaucoma drainage devices. We herein propose the use of iOCT as an adjunctive tool in the guidance and positioning of a glaucoma drainage device into the anterior chamber and sulcus space when direct visualization of the needle entry is precluded by corneal opacity, and we test this concept using cadaveric eyes. Placement of the glaucoma drainage device tube in the sulcus is often desired in patients with pseudophakia to decrease the risk of corneal edema that can occur with anterior chamber placement.