Evaluation of LTK lesions by optical low coherence tomography (OCT) and polarization microscopy after Sirius-Red staining

Background: Information on the extent and degree of the thermal effect produced is of great importance for control of the laser dosage in laser thermokeratoplasty (LTK) and for postoperative follow-up. We investigated on acute LTK effects which information images obtained by optical low coherence tomography (OCT) offer compared to those obtained by polarization microscopy. Methods: Porcine eyes were irradiated through a 400 mu m quartz fiber using light from a laser diode emitting up to 300 mW at a wavelength of 1.86 mu m. Thermal lesions of varying strength were scanned using an experimental OCT device with about 25 mu m lateral and 20 mu m axial resolution. Histologic evaluation of the scanned areas was done by polarization microscopy after Sirius-Red staining, and similar lesions were also analyzed by TEM. Results: Both methods differentiated three damage zones: a transition zone, a zone of moderate coagulation, and a central zone of strong coagulation. In the transition zone,increased birefringence was seen in polarization microscopy, which correlated with increased light scattering seen in the DCT images,ln the moderately coagulated zone, a decrease in birefringence was associated with an even stronger increase of the OCT signal, In the central zone,a loss of the fibrillar tissue structure was observed, which led to a complete loss of birefringence and a strong reduction of the OCT signal. Conclusions: Although OCT does not provide the detailed information on thermal changes of tissue seen by the histologic method, it offers information on the extent and degree of tissue changes without preparation artifacts and provides a non-invasive method of immediate and follow-up control of LTK lesions, A quantitative analysis of changes in corneal thickness and curvature is much simpler than by a slit lamp. Time-resolved measurements of corneal light scattering may be used for on-line control of the laser-light dosage during LTK.