Intraoperative anterior optical coherence tomography-guided synechiolysis in a post-penetrating keratoplasty patient with peripheral corneal opacification

The aim of this study was to describe intraoperative optical coherence tomography (OCT) as an adjunctive device for peripheral synechiolysis in a post-penetrating keratoplasty patient. A 75-year-old female patient presented for follow-up 9 months after a penetrating keratoplasty in the left eye. She presented with anterior peripheral synechiae involving the graft for three clock hours. Peripheral native cornea appeared totally opaque. Synechiolysis was planned, and intraoperative OCT allowed us to detect nonclinically visible synechiae and to confirm complete synechiolysis immediately after surgery. No postoperative complication was recorded. Two months after surgery, the graft was clear and anterior segment OCT did not reveal any residual synechiae or recurrence. Intraoperative OCT is useful to overcome the difficulties in visualization through clinically opaque corneas, as it gives real-time feedback upon the anatomy, the extension of the remaining lesions, and the success of the surgery.