Downward viewing common-path optical coherence tomography guided hydro-dissection needle for DALK

Deep anterior lamellar keratoplasty (DALK) is a partial-thickness cornea transplant procedure in which only the recipient's stroma is replaced, leaving the host's Descemet's membrane (DM) and endothelium intact. This highly challenging "Big Bubble" procedure requires micron accuracy to insert a hydro-dissection needle as close as possible to the DM. Here, we report the design and evaluation of a downward viewing common-path optical coherence tomography (OCT) guided hydro-dissection needle for DALK. This design offers the flexibility of using different insertion angles and needle sizes. With the fiber situated outside the needle and eye, the needle can use its' full lumen for a smoother air/fluid injection and image quality is improved. The common-path OCT probe uses a bare optical fiber with its tip cleaved at the right angle for both reference and sample arm which is encapsulated in a 25-gauge stainless still tube. The fiber was set up vertically with a half-ball epoxy lens at the end to provide an A-scan with an 11-degree downward field of view. The hydro dissection needle was set up at 70 degrees from vertical and the relative position between the fiber end and the needle tip remained constant during the insertion. The fiber and needle were aligned by a customized needle driver to allow the needle tip and tissue underneath to both be imaged within the same A-scan. Fresh porcine eyes (N = 5) were used for the studies. The needle tip position, the stroma, and DM were successfully identified from the A-scan during the whole insertion process. The results showed the downward viewing OCT distal sensor can accurately guide the needle insertion for DALK and improved the average insertion depth compared to freehand insertion.