Purpose: To report the first live intraoperative documentation of Dua's layer detachment using microscope-integrated optical coherence tomography (MiOCT) during big-bubble DALK, resulting in a triple anterior chamber and its successful MiOCT-guided management. Case report: A 32-year-old man with bilateral macular corneal dystrophy underwent MiOCT-assisted DALK in the right eye. During viscoelastic injection, MiOCT revealed real-time detachment of the pre-Descemet (Dua's) layer, creating 3 distinct fluid-filled compartments. Conservative observation failed to resolve the detachment. On postoperative day 3, MiOCT-guided interface drainage with a venting incision and air tamponade (descemetopexy) led to complete anatomical reapposition. Final BCVA improved to 6/12 within 3 weeks. Conclusions: To the best of our knowledge, this is the first case to demonstrate intraoperative MiOCT visualization of Dua's layer separation and resulting triple anterior chamber. The report underscores the critical role of MiOCT in identifying subtle lamellar complications in real time and guiding successful surgical intervention.
Jain et al. (Sun,) studied this question.