Eyeworld

58 | EYEWORLD | WINTER 2024 C ORNEA by Julie Schallhorn, MD Cornea Editor T he articles in this issue capture the promise of new therapies and new options for the care of corneal disease. One of my favorite things about our field is the energy and pure delight with which physicians, our industry partners, and regulatory bodies continue to advance our ability to care for patients. This is highlighted in our YES Connect column with Elvia Canseco, MD, and Shaily Shah, MD, on new dry eye ther- apeutics and from the outstanding advice we receive from Anat Galor, MD, MSPH, Stephen Pflugfelder, MD, and John Sheppard, MD, on preservative toxicity. We also hear from William Boyd, MD, Deputy Division Director with the U.S. FDA's Center for Drug Evaluation and Research, who shares valuable insights on the government's role in developments in our field. With any advancement comes change, and sometimes these shift our current paradigm of care. This issue's article on cultured endotheli- al cell therapy, with Albert Jun, MD, PhD, Ula Jurkunas, MD, Ellen Koo, MD, and W. Barry Lee, MD, heralds a new epoch in the care of corneal diseases. The ability to treat corneal edema with a straightforward procedure that avoids invasive surgery is a remarkable advancement in our field, and one that holds enormous promise for improvements in patient outcomes. We have already been riding the wave of another advancement in corneal transplanta- tion, endothelial keratoplasty. Whether you are an adherent of DMEK or prefer DSAEK, both procedures have undoubtedly transformed the way we care for corneal edema. The adoption of these procedures was not straightforward; there was a distinct learning curve for both as surgeons young and old learned the nuances of manipulating a thin tissue disc inside the anterior chamber. There were follies, dropped grafts into the back of the eye, DMEKs acciden- tally injected onto the ocular surface or lost in preparation, but also remarkable successes in the development of methods that made these procedures safe and effective in the hands of corneal surgeons worldwide. The procedures as they stand now offer superior visual outcomes to a penetrating keratoplasty and a much-re- duced risk profile. As I look ahead at the coming of cultured endothelial cell therapies, I have a growing rec- ognition that these will likely mark the end of endothelial keratoplasty as we know it. This is for the unequivocal benefit of the patient if the promise of reduced risks and decreased need for donors indeed holds true. However, there is a small part of me that is mourning the loss of an elegant procedure and with it the specialization and expertise of that part of our field. The way we care for patients changes from year to year, in big ways and in small. Cultured endothelial cell therapies represent a massive shift in how patients with endothelial dysfunc- tion will be treated, and that means a loss of a procedure cherished by corneal surgeons. With any new beginning, we come to the end of something else. In this case, I am enthusiastic for the benefits it will bring our patients and for the improvement in the level of care we are able to provide. However, I will remember the ingenuity that went into the development of endothelial keratoplasty and the supreme teach- ing and innovation that made it a procedure adopted worldwide. New beginnings With any new beginning, we come to the end of something else. In this case, I am enthusiastic for the benefits it will bring our patients and for the improvement in the level of care we are able to provide.

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