Cornea Society News

JUL 2017

Cornea Society International Organization Advancing the treatment of corneal disease

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News July 2017 Vol. 14, No. 2 A Cornea Society publication Cornea Day highlights global hot topics, corneal complications, and more I n the "Global Hot Topics" session of the 2017 Cornea Day at the ASCRS•ASOA Symposium & Con- gress, presenters discussed ocular surface reconstruction, Zika virus and the eye, the Asia Cornea Society Infec- tious Keratitis Study, management of bilateral limbal stem cell deficiency, addressing corneal blindness, global eye bank development, bioengineered corneas, transplantation of ex vivo ex- panded human corneal endothelial cells, producing corneal cells from induced pluripotent stem cells (iPS), and using long-term preserved corneas for DALK. Maria Cortina, MD, Chicago, dis- cussed why she thinks the Boston KPro is the treatment of choice in bilateral limbal stem cell deficiency (LSCD). Surgical options for bilateral LSCD treatment fall into two categories: cell- based therapies and keratoprosthesis. Cell-based procedures can be broken down into allogeneic and autologous. For keratoprosthesis, there are different devices for dry ocular surface and wet ocular surface. Dr. Cortina spoke about the Boston type 1 KPro for wet ocular surface, which she said is the clear winner. It avoids the need for immunosup- pression, she said. There is also faster visual rehabilitation, and it's available worldwide. She did note that this type of KPro requires corneal tissue as a carrier, and there is a risk of sight-threatening complications. It's best approached by a multidisciplinary team. Dr. Cortina said that the Boston type 1 KPro has good visual acuity re- sults and long-term retention in patients with LSCD. It avoids the long-term risk of systemic immunosuppression needed for allogeneic transplantation. Patients should be followed closely and managed by an experienced team, since some sight-threatening complications can oc- cur. Although there is limited evidence, Dr. Cortina said the evidence available suggests that long-term KPro outcomes are superior to cell-based therapies. However, she noted that more long-term studies and/or a randomized clinical trial would be helpful to further guide treatment choices in cases of bilateral LSCD. Another session of Cornea Day fea- tured point-counterpoint discussions on a variety of topics. Keith Walter, MD, Winston-Salem, North Carolina, and Melissa Daluvoy, MD, Durham, North Carolina, spoke on either side of "Fuchs' Dystrophy and Cataract: Combined EK Triple vs. Staged Procedure." Dr. Walter argued for a combined procedure, which he said makes life easier for everyone. Dr. Walter noted that when the cataract is done first, you make the patient's vision worse either immediately or in the near future. You could also cause the patient unneces- sary pain or an infection from ruptured bullae. When Descemet's stripping endo- thelial keratoplasty (DSEK) or Descemet's membrane endothelial keratoplasty (DMEK) is done first, Dr. Walter said you aren't doing the patient any favors either. This could still result in cataract formation and a risk for graft failure from the additional ultrasound trauma to the new graft. Dr. Walter said there are many advantages of combined procedures. Combining can save the patient and family an extra trip to the OR, and there is faster visual recovery. Dr. Walter noted that you can use the same incision for both procedures, you just have to slight- ly enlarge it. It's easy to accomplish both procedures with minimal additional instrumentation or skill. It also saves OR time. Dr. Walter shared considerations when combining procedures. First, he said it's important to know how the view will be during surgery. Severe edema may obscure the view. "You need to consider astigmatism management because the incision is a little larger," he added. Accurate Ks and IOL selection are Dr. Daluvoy discusses why she prefers separate procedures in Fuchs' dystrophy and cataract cases. continued on page 3

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