Intraoperative Anterior Segment OCT-Assisted Removal of Misdirected Intracorneal Viscoelastic Substance in Iatrogenic Descemetolysis

Sodium hyaluronate 1% was first introduced to ophthalmic surgery in 1979 from Drs. Stegmann and Miller during cataract surgery [1]. Ophthalmic viscoelastic devices (OVDs) are widely used in anterior segment surgery, among others, in order to maintain anterior chamber depth intraoperatively and to protect the corneal endothelium [2]. Since the first use of sodium hyaluronate 1%, other viscoelastic agents have been developed and introduced into the operating theater, such as combinations of natrium hyaluronate with chondroitin sulfate and natrium hyaluronate with lidocaine hydrochloride [3], [4]. Intraoperative anterior segment ocular coherence tomography (i-AS-OCT) was first introduced in 2005 and offers the ability to assess the structures of anterior segment in real-time during surgery [5]. Of great importance is the noninvasive nature of OCT as well as the easy use of the device, which is often integrated in the surgical microscope [6].