JAN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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January 2013 Cornea continued from page 30 OCT image of a post-op thin DSAEK; central donor thickness is 100 μm Source: Edward J. Holland, M.D. Technique preferences Dr. Busin said he is currently seeing a trend toward thin DSAEK, his preferred method. This allows for thinner grafts and thinner incisions with the DSAEK procedure. However, he said that some people may not trust this method yet, which could be why some are leaning toward DMEK. He said in the future he expects to see people favoring thin DSAEK. "The ease of surgery and the outcome, which is more or less the same, would convince them to move from DMEK back to thin DSAEK grafts," Dr. Busin said. Likewise, Dr. Ang also said thin DSAEK is presently her procedure of choice. "This technique results in excellent visual outcomes, is technically less demanding than DMEK, and has fewer complications than DMEK at present," she said. Dr. Price said he prefers the DMEK technique, although he still sometimes uses DSAEK. "If it's a non-complicated case, we recommend DMEK," he said. After nearly five years using DMEK, there are a number of reasons he favors it. He said better vision results are evident with DMEK. Another reason is rejection rates are significantly lower with DMEK. He said in a cumulative look at DMEK for a two-year period, the rejection rate was less than 1%, compared to about 12% for DSAEK. He said thin DSAEK does offer some similarities to DMEK. "I think the thinner it gets, the closer you're going to get to DMEK," he said. But the question, he said, is how close you can get and how reliable the thin DSAEK would be. Dr. Price said he stopped using thin DSAEK because of significant tissue loss in donor preparation. Currently DMEK donor loss rates are less than 1%; it will be interesting to see if donor loss rates will be that low if all donor preparations for DSAEK are for thin cuts, as there is always some irregularity and unpredictability with microkeratome cuts. Endothelial replacement future Endothelial keratoplasty has evolved over the years, Dr. Ang said. "The next phase will be cultured donor endothelial cell seeding of diseased corneas," she said. "The ability to culture and expand donor endothelial cells will increase the donor supply, especially in countries with limited supply. These cells could be transplanted either as an injectionbased therapy or on a carrier." EW Editors' note: Dr. Busin has financial interests with Moria. Drs. Ang and Price have no financial interests related to this article. Contact information: Ang: angandrea@hotmail.com Busin: mbusin@yahoo.com Price: francisprice@pricevisiongroup.net EyeWorld @EWNews Follow EyeWorld on Twitter at twitter.com/EWNews Find us on social media Are you a fan of EyeWorld? Like us on Facebook at facebook.com/EyeWorldMagazine

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