EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
February 2013 procedure. Using the taco folding technique for inserting donor tissue used in countries like the U.S., he and his colleagues were alarmed to find an initial endothelial cell loss of 30% post-op, going up to over 60% at one year���results that were reinforced and closely replicated in Japan. They thus introduced the sheets glide technique. Using the sheets glide, a large incision, and a pullthrough technique, the SNEC team was able to reduce the initial loss to 9%, with a clear cornea at day 1. It still was not ideal���the pullthrough could damage the donor rim, the sheets glide is open so the donor tissue is not protected and may slip, and requires a degree of ambidexterity. So the SNEC team developed the EndoGlide. The earliest version of the EndoGlide���the design inspired by thumb drives���produced double coiling of the donor tissue, allowing surgeons to insert larger donor tissues through smaller incisions. More importantly, the EndoGlide gave the surgeon full control of the donor tissue at all times until insertion is completed. The EndoGlide reduced oneyear endothelial cell losses from 19% to 15.6%, then 14.9% as they performed more cases and surgeons grew more comfortable with the technique. The more recent preference for thinner donor tissue���such as in Descemet���s membrane endothelial keratoplasty (DMEK)���led the SNEC team to develop a new iteration of the EndoGlide. The EndoGlide Ultrathin introduces a saddle to the design to more gently curve the tissue while loading. The ideal approach to endothelial disease, however, is to cultivate human corneal endothelial cells. The first problem was to find a medium in which cultivated cells would follow the morphology of normal corneal tissue���with most media, cultivated cells grow chaotic and spindle shaped. M5 appears to be just the medium needed for the procedure, and now what���s needed is a carrier���a RAFT (real architecture for 3D tissue), made of plastic compressed collagen. Using cultivated endothelial cells for treating endothelial disease remains some years down the road, but with Dr. Mehta and his colleagues working on it, the future of endothelial keratoplasty is just over the horizon. Dr. Mehta delivered this year���s Nakajima Award Lecture in a symposium on ���Current trends in posterior lamellar cornea surgery: A revolution in evolution.��� Editors��� note: Dr. Mehta is part of the team that developed the EndoGlide, but has no financial interests related to his lecture. Perspectives on dif���cult glaucoma The International Academy of Ophthalmology includes the world���s senior members of ophthalmologic academia and was established to promote academic ophthalmology and EW MEETING REPORTER 91 education. One of the strengths of the Academy is its ability to draw on experts from a variety of different subspecialties to offer their perspectives on issues on which the discourse might otherwise be confined to experts within a single specialization. This was exemplified by the Academy symposium on the management of difficult glaucoma. Glaucoma is an epidemiologically significant condition in the Asiacontinued on page 92