'Acute-angled bevel' sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty. Issue 2 (21st February 2019)

• Record Type: Journal Article
• Authors: Titiyal, Jeewan S; Kaur, Manpreet; Shaikh, Farin; Bari, Aafreen
• Is Part Of: BMJ case reports. Volume 12:Issue 2(2019)
• Publication Date: 2019-02-21
• Subjects: ophthalmology -- anterior chamber; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-227927
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 6.5-year-old boy with congenital hereditary endothelial dystrophy underwent clear corneal ultra-thin descemet stripping automated endothelial keratoplasty (DSAEK). After graft insertion, it was difficult to assess graft orientation due to hazy cornea. Intraoperative optical coherence tomography (iOCT) showed a well-attached graft and the bevelled edge of donor lenticule made an acute angle with the overlying stroma. Postoperative anterior segment OCT confirmed the presence of acute-angled bevel sign. A wetlab experiment was performed with experimental corneoscleral tissues to confirm the findings. Donor lenticule was injected in the artificial chamber with stromal-side up as well as stromal side-down. 'Acute-angled bevel sign' was observed on iOCT in the experimental cases with stromal-side up. In inverse graft, the acute-angled bevel was not observed, instead the configuration was obtuse angled. Identifying the 'acute-angled bevel sign' on iOCT confirms correct graft orientation after unfolding and is extremely useful for hazy corneas and ultrathin DSAEK lenticules.