Cornea Society News

WIN 2012

Cornea Society International Organization Advancing the treatment of corneal disease

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Cornea Society News A C o r n e a S o c i e t y P u b l i c a t i o n J a n u a r y 2 0 1 2 V o l 8 , N o . 1 (fDMAEK) yielded greater endothelial cell loss than manual DMEK prepara- tion or DSAEK procedures. Conversely, femtosecond lasers may aid in more predictable big bubble formation in DMAEK. Prosthetic lenses show promise In patients with severe ocular surface disease, a prosthetic rehabilitation of the ocular surface ecosystem (PROSE) offers "improved visual acuity and visu- al function," said Kristen Hawthorne, MD. At 6 months, patients with neu- rotrophic keratitis, exposure, Stevens- Johnson syndrome, and graft-vs.-host disease were likely to still be wearing the device. A lower success rate was seen in patients with a self-reported diagnosis of anxiety, depression, or fatigue. The scleral lens she described has a Dk of about 88, "which is around what typical gas permeable contact lenses are," she said. "It's not the piece of plastic that matters, it's the fit." Two other presentations on the Boston Type 1 KPro found it to be a viable option outside the U.S. to man- age repeat graft failure and chemical injuries. Gamma irradiated, femtosec- ond pre-cut corneal lenticules without viable endothelium may be a good alternative to fresh corneal tissue in KPro procedures. CDS projections A greater restriction on donor age and endothelial cell density would decrease availability and increase cost, said Kevin Ross, MPH. A 2-year retrospective analysis of 10,310 donor corneas (from 9,365 donors) evaluated the impact of endothelial cell density and donor age Cornea Society/EBAA Fall Educational Symposium lives up to name T he 2011 Cornea Society/EBAA Fall Educational Symposium, moderated by Sadeer B. Hannush, MD, and Stephen C. Kaufman, MD, offered a full day's worth of science on advances in endothelial, lamellar, and penetrating keratoplasty procedures; keratoprothe- ses; and more. The opening paper of the session set the tone for the high caliber scien- tific discussions that would follow. Mark A. Terry, MD, found the amount of time donor tissue is stored before use impacts neither the cell count nor com- plication rates, and commented the "upper limit of how long we can wait before using the tissue is unknown." Those results may have an impact continued on page 3 outside the U.S. as well, where donor grafts may be 4-5 days old before use, he added. Although time-to-use was not measured in a different retrospec- tive study in India on pediatric DSEK graft survival, at the end of 1 year 86% of pediatric grafts survived, according to Jatin Ashar, MD. Moving to surgical techniques, Massimo Busin, MD, said ultra-thin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) may be the "ideal graft for EK proce- dures," as it offers the rapid visual recovery of DMEK but is easier to per- form. In 152 surgeries with 1-, 3-, 6-, and 12-month follow-up, BCVA of 20/20 was achieved in 41%; 82% were 20/25 or better at 6 months, he said. "The fastest and best recoveries were in phakic patients," he said. His two-step procedure involves one pass with a 300-micron head and the second with a 50-micron head. As a proponent of DMEK, Francis W. Price Jr., MD, spoke about using a roughened bimanual aspiration hand- piece to "polish" the peripheral recipient bed to reduce the rate of air reinjection after DMEK. "Without polishing, air reinjection was necessary in 46 of 100 eyes," he said. "With polishing, the air reinjec- tion rate was significantly lower at eight of 32 eyes (25%)." In phakic patients he recommended injecting earlier than in pseudophakes. DMEK/DMAEK procedures will continue to gain converts because of their potentially better visual out- comes, said Winston Chamberlain, MD. However, using a femtosecond laser to prepare donor corneas Andrea Ang, MD, accepts the Best Paper Award from David Glasser, MD, Marian Macsai, MD, and Monty Montoya

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