Cornea Society News

WIN 2015

Cornea Society International Organization Advancing the treatment of corneal disease

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News Winter 2015 Vol. 11, No. 1 A Cornea Society publication Cornea pearls highlighted at Fall Educational Symposium A ttendees at the Cornea Society/ Eye Bank Association of Ameri- ca Fall Educational Symposium in Chicago heard the latest pearls and results from studies related to Descemet's membrane endothelial keratoplasty (DMEK), Descemet's strip- ping automated endothelial keratoplasty (DSAEK), and deep anterior lamellar ker- atoplasty (DALK), among other topics. P. James Sanchez, MD, Los Angeles, and co-investigators reported that DMEK performed using eye bank-prepared DMEK tissues can have excellent out- comes. The researchers led a retrospective observational study with the first 38 consecutive DMEK procedures performed by a single surgeon using pre-stripped DMEK tissues prepared by a single eye bank. There were no cases of total detach- ment, upside down graft, or infection. Research with the "bubble in the roll" technique for DMEK focused on a safe and reliable approach for reproduc- ible delivery of DM grafts in DMEK in a presentation given by Friedrich Kruse, MD, Germany. "The 'bubble in the roll' technique ensured correct position of the DM roll—overlap facing upward— at the end of injection in 248 of 250 consecutive DMEK surgeries and reten- tion of the tiny air bubble in 242 of 250 surgeries," Dr. Kruse reported. The tech- nique appears to overcome limitations of current graft injection techniques, Dr. Kruse and co-investigators concluded. They noted that current injection techniques implicate a random position of the graft after injection. Although rejection rates after DMEK are much lower than those reported after DSAEK or penetrating keratoplas- ty, it can still occur. Mark Terry, MD, Portland, Ore., examined rejection rates following the use of a standardized postop steroid regimen. Researchers reviewed 223 consecutive DMEK eyes at 3 months or more postop. Patients used prednisolone acetate 1% on a standard regimen of 4 times a day for the first 3 months; their dosage was decreased ev- ery quarter unless it had to be modified for IOP issues. Steroids were stopped at 1 year. Four eyes experienced a rejection episode within the first 2 years after DMEK, leading to a 1.7% rejection rate. "All cases resolved the rejection episode after boosting topical steroid therapy, and all retained corneal clarity and excellent vision," Dr. Terry reported. Dr. Terry and fellow researchers concluded that rejection of DMEK donors can occur even with the use of potent steroid therapy and that stopping steroids at 1 year postop may be reasonable. Anthony Kuo, MD, Durham, N.C., reported on the use of intrasurgical swept-source microscope integrated optical coherence tomography (OCT) for real-time guidance during DALK. The microscope was used both ex vivo and in vivo. Researchers found that intrasur- gical OCT can help monitor and guide the surgeon in real time during DALK. "Unlike regular surgical microscopes, ultra-high speed swept-source micro- scope OCT enables surgeons to directly assess lamellar dissection depth, needle depth, and big bubble creation," Dr. Kuo concluded. Reporting results from the Cor- nea Donor Study, Jonathan Lass, MD, Cleveland, and co-researchers examined the long-term effect of donor diabetes history on graft failure and endotheli- al cell density (ECD) after penetrating keratoplasty. Researchers did not find a statistically significant association of donor diabetes history with 10-year graft failure, baseline ECD, 10-year ECD, or ECD values longitudinally over time in unadjusted analyses or after researchers adjusted for donor age and other co- variates. There was a 23% 10-year graft failure rate in the 199 cases that received a cornea from a donor with diabetes, compared with 26% in the 891 cases that received a cornea from a donor who did not have diabetes. Researchers con- cluded that diabetes was defined only by historical data and that further study of graft success and cell loss is needed, along with more precise measures of donor and recipient diabetes. Other highlights from the Fall Educational Symposium included the Claes H. Dohlman, MD, PhD Award presentation, the R. Townley Paton Award Lecture, and the Best Paper Award. CN Marian S. Macsai, MD, and Douglas Lazzaro, MD, present the Troutman Prize to Fei-fei Huang, MM, at the Fall Educational Symposium.

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