1. Analysis of Clear Corneal Incision Architecture with Anterior Segment Spectral-Domain OCT Theodore Leng, MD, Jianhua Wang, MD, PhD, Sonia H. Yoo, MD, Brandon Lujan, MD, Aizhu Tao, MD, Gavriil Tsechpenakis, PhD Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL USA The authors have no financial disclosures. This presentation discusses the use of an experimental medical device that has not yet been approved by the FDA.

2. Purpose To use a prototype AS-SDOCT device to image bi- and tri-planar CCIs constructed for phacoemulsification and to reconstruct those wounds in three-dimensional (3D) space Advantages of AS-SDOCT Higher axial resolution Faster acquisition speed Allows for 3D scans Wound features can be analyzed across the full dimensions of the incision Ability to reconstruct wound in 3D

3. Materials and Methods A prototype 1310 nm wavelength AS-SDOCT instrument was constructed and mounted onto a conventional slit lamp for imaging of the anterior segment. The device had an axial resolution of 8 μm and was able to acquire real-time two-dimensional images at 14 frames/second and full 3D datasets in approximately 7 seconds. AS-SDOCT datasets of 100 B-scans, each consisting of 512 A-scans, were acquired from each patient on post- operative day one after uncomplicated cataract extraction by phacoemulsification. Each 3D scan consisted of a 6 x 6 x 3 mm volume of data. The experimental protocol was approved by an institutional review board and all patients underwent an informed consent process and signed a consent form. The Prototype AS-SDOCT Device The device (black box) as seen mounted on a conventional slit lamp

4. Results En face image of the cornea B-scan depicting a CCI (arrow) Please see movie file for 3D manipulation of data

5. The incision is traced on individual B-scans to create a surface depiction of the CCI geometry

6. Data Analysis Compared surgical technique to actual wound shape on OCT scansCompared surgical technique to actual wound shape on OCT scans Analyzed wounds for characteristics possibly associated with ingress of fluid and endophthalmitisAnalyzed wounds for characteristics possibly associated with ingress of fluid and endophthalmitis 13 “bi-planar” wounds scanned 13 “bi-planar” wounds scanned 10 “tri-planar” wounds scanned 10 “tri-planar” wounds scanned Loss of Coaptation Bi-Planar 1 of 131 of 13 Tri-Planar 0 of 100 of 10

7. Geometry Bi-Planar 3 of 13 (23%) had true bi-planar geometry3 of 13 (23%) had true bi-planar geometry Remainder had curvilinear Remainder had curvilinear Tri-Planar 6 of 10 (60%) had true tri-planar geometry Of the remainder: Combined Bi and Tri (1) Pure bi-planar (1) Curvilinear (2)

8. Wound Gape Epithelial Side 1 of 13 bi-planar1 of 13 bi-planar 1 of 10 tri-planar1 of 10 tri-planar Endothelial Side 1 of 13 bi-planar1 of 13 bi-planar 5 of 10 tri-planar5 of 10 tri-planar

9. Misalignment Bi-Planar Epithelial - NoneEpithelial - None Endothelial - 2 of 13Endothelial - 2 of 13Tri-Planar Epithelial – NoneEpithelial – None Endothelial – 1 of 10Endothelial – 1 of 10

10. Stromal Edema Bi-Planar 3 of 133 of 13 Greater in Roof - 2Greater in Roof - 2 Greater in Floor - 1Greater in Floor - 1Tri-Planar 4 of 104 of 10 Greater in Roof - 3Greater in Roof - 3 Variable throughout width of wound - 1Variable throughout width of wound - 1

11. Descemet’s Detachments Bi-Planar 9 of 139 of 13Tri-Planar 2 of 102 of 10

12. Conclusions Tri-planar techniques were likely to result in true tri-planar geometry on AS-SDOCT scansTri-planar techniques were likely to result in true tri-planar geometry on AS-SDOCT scans Tri-planar CCIs had a higher incidence of wound gape than bi-planar CCIsTri-planar CCIs had a higher incidence of wound gape than bi-planar CCIs Neither technique had a high rate of loss of coaptationNeither technique had a high rate of loss of coaptation Both techniques had an equal rate of misalignment and stromal edemaBoth techniques had an equal rate of misalignment and stromal edema Bi-planar technique was more likely to result in Descemet’s detachmentsBi-planar technique was more likely to result in Descemet’s detachments Future Directions Improved wound reconstructions Calculation of wound surface area (which may be related to leakage and rates of endophthalmitis) Measurement of wound lengths and angles Decrease image acquisition time to reduce motion artifiact