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 S p o ns o r e d F e a tu r eSeeing
The Difference
Two ophthalmologists share how
Topcon’s DRI OCT Triton makesa difference in their clinics.
By Julian Upton

S p o ns o r e d F e a tu r e

Topcon Healthcare (Tokyo, Japan), a marketleader in the field of Optical Coherence
Tomography (OCT) instrumentation,
has consistently developed and innovatedspectral domain (SD) and swept-source(SS) OCT technologies.
DRI OCT Triton represents the thirdgeneration of OCT technology andcombines deep scanning capabilities
with the ability to penetrate media
opacities with ultra-fast SS imaging(100,000 A-scans/s). Triton has theability to capture comprehensive retinal
and choroidal data in a single scan andproduces more images to enhance
the clinical decision-making process. In
addition, Triton uses stereo photography
to capture true-color fundus images
in 3D, and thanks to its auto-mosaic
panorama function, Triton provides wide
coverage of the retina into the periphery(which includes most of the fundus).

contact lens and local treatment with
topical antibiotic 4 times daily for 5 days,steroid (Prednisolone acetate) eye drops
6 times daily and Bromfenac eye drops
2 times daily.
One week after uncomplicated DMEK
surgery, a slight inferior graft detachment
was observed. The topical treatmentof steroid eye drops 6 times daily withmonthly tapering and Bromfenac 2 times
daily were continued.
Corneal imaging was performed at
the two-week postoperative followup using anterior segment Triton OCT(Topcon, Japan) (Figures 1& 2). The
transplant detachment can be detected2using the line scan and localized to thecornea’s inferior part. Due to Triton’s
swept-source technology, the corneal
and scleral tissue were easily penetrated,allowing for detailed visualization of theanterior chamber structures, including
the transplant detachment, with a highdegree of clarity.

CASE STUDY TWO:CASE STUDY ONE:DMEK Graft Detachment
Oliver Findl, Chief of the Departmentof Ophthalmology at the Vienna
Hanusch Hospital.
A 79-year-old Caucasian male presented
to our cor nea depar tment wi th
decreased visual acuity in the left eye,persisting after uncomplicated cataract
surgery of both eyes.
Two months prior to presentation,cataract surgery had been performed in ourdepartment. At the time, the preoperative
examination revealed a clear cornea, deepanterior chamber with nuclear cataract andnormal retinal examination for both eyes.
The IOL power calculation was performed
using IOLMaster 700 (Carl Zeiss Meditec,Dublin, California, USA): OD: keratometry
8.27@88/ 7.66@178, ACD: 2.77, AL: 22.46
mm. OS: keratometry 7.96@ 77/ 7.80 @167, ACD: 2.78, AL: 23.38 mm. A 24.00 D/ 4.00 cyl monofocal toric lens (Zeiss ATTorbi 709) was implanted at 178 degrees
in the right eye and a standard monofocal
intraocular lens was implanted in the left eye.
At examination (two months after cataract
surgery), the patient’s best corrected visualacuity was 0.8 in the right eye and handmotion in the left eye. Autorefraction
was: -0.25 -0.50 X 19 (right eye) and-2.50 -2.50 X 148 (left eye). The slit-lamp
examination revealed a clear cornea, withdeep anterior chamber and pseudophakia
for the right eye and corneal oedema,
Descemet folds, and pseudophakia forthe left eye. No other ocular structures
were visible due to the corneal oedema inthe left eye. The central corneal thickness

Figure 1. Line Anterior segment OCT (Triton)

Figure2. Anterior segment OCT 3.0x3.0mm

two week after DMEK surgery, inferior(Triton) two weeks post-DMEK surgery

detachment of the transplant can be seentransplant folds can be seen.

(CCT) of the left eye was 760 μm.
Ropasudil (GLANATEC® ophthalmic
solution 0.4%) eye drops 3 times daily andOmni-Sorb® NaCl 5% eye drops 3 times
daily were started in the left eye, with aplanned follow-up examinations at 2 weeks(after first presentation to our department),
2 months, and 3 months.
At the two-week appointment, a slight
improvement of the left eye cornea wasobserved, with the oedema (CCT 650μm) now concentrated within the 5 mm
central area of the cornea. Treatment withRopasudil and NaCl drops were continued
at the same intervals.
At the two months follow-up, the best
corrected visual acuity of the right eye was0.63 and 0.1 for the left eye. The left eye CCT
was 584 μm and the slit-lamp examination
revealed central corneal oedema, deepanterior chamber, pseudophakia and anormal retinal examination. Ropasudil eyedrops 3 times daily were continued, with afollow-up scheduled for one month.
Three months post-cataract surgery, thepatient presented with increased corneal
oedema inferiorly (CCT 650 μm) in the left
eye despite the use of Ropasudil eye drops,
thus a Descemet Membrane Endothelial
Keratoplasty (DMEK) surgery was planned.
DMEK surgery of the left eye wasperformed a month later under local
anaesthesia. At the conclusion of thesurgery, the patient received a bandage

Fungal Keratitis and graft rejection
Mr Mark Lane is an ST7 Ophthalmology
trainee in the West Midlands Deanery. Heis specializing in the cornea and anterior
segment, and is due to start a post-training
fellowship in Moorfields in August 2023.
A 19-year-old male patient presented to thespecialist corneal clinic for ongoing therapy.
The patient has a history of severe eczema
affecting the face and periocular region that
required systemic immunosuppression .
Due to his associated ocular surface disease,he had previously suffered from bilateralcorneal perforations requiring emergency
management and a tectonic corneal graft tothe right eye. The patient initially regained
vision in the postoperative period. He later
developed fungal keratitis in the tectonic
corneal graft and was treated with topicalvoriconazole, natamycin and intrastromalamphotericin B and levofloxacin drops.
On clinical examination, the patient’s
vision was hand movements, and heappeared to have a chronic corneal graft
failure. The anterior color photographindicates a generalized corneal haze andoedema with no evidence of recurrenceof the fungal infiltrate. (Fig. 1)
The AS OCT (Fig. 2 and 3) (Topcon DRIOCT Triton, Tokyo, Japan) demonstrated
the presence of dense fibrin plaque in theanterior segment that was adherent to theendothelium. The extensive inflammation

Figure 1..

Figure 3..

Figure 2..

Figure 4..

Figure 5..

visualised with the OCT helped to diagnosean acute graft rejection and guide histreatment, to increase his topical steroids
despite his recent fungal keratitis.
Three months later, the inflammation had
improved, and the patient was no longer
in acute rejection. The anterior segment
OCT and colour photograph (Fig. 4 and5) indicate a scarred cornea with a clear
anterior chamber
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