Eyeworld

WINTER 2026 | EYEWORLD | 73 C Contact Armenti: Stephen.Armenti@ Pennmedicine.upenn.edu Jeng: Bennie.Jeng@Pennmedicine. upenn.edu Relevant disclosures Armenti: None Jeng: None 10 years their correctable vision is 20/20 with a contact lens, but they can't wear contact lenses, so they walk around with 20/200 vision because of a significant amount of irregular astigma- tism," Dr. Jeng said, adding that this could be because they can't get the contact lens in their eye or they work in the construction industry and constantly have dust in their eye, for ex- ample. In this situation, if their habitual vision is poor, and the endothelial cells fail and you replace only the posterior part of the cornea, you're giving them back the same poor habitual visual correction that they had before. In these cases, Dr. Jeng said it's worth discussing a PK. Using a PK, potentially with a running suture, and trying to adjust the astigmatism could help this patient have a better visual outcome. Additionally, if you have a patient with a dense corneal scar and endothelial failure, PK is still a very viable procedure. In terms of learning and keeping up with both EK and PK skills, Dr. Armenti said all aspects of corneal transplantation are taught in his fellowship program. He thinks that PK is probably one of the easier things to teach early trainees—how to suture, how to decide whether it's appropriate treatment, and the actual per- formance of the surgery. It can be learned a bit quicker than EK, he said. Postoperative manage- ment can be more challenging, and it is critical for trainees to acquire this skill as well. Since it's a full thickness transplant, the patient can perforate and rupture the graft, so there's that lifelong risk, he said. With EK, since you often will know within the first week or two if it was successful, this can be less of an issue. Penetrating keratoplasty with running suture Source: Stephen E. Orlin, MD Marjan Farid, MD, EyeWorld Cornea Editorial Board member, commented on new tools, techniques, and challenges in anterior segment surgery: "I am most excited about injectable endo- thelial cell therapy for the treatment of cor- neal endothelial disease. It has the potential to fundamentally change how we approach corneal disease. We would no longer need to depend on donor tissue availability and technically demanding transplantation. It allows us to restore endothelial function through a scalable treatment, bringing sight-restoring therapy to many corneal blind patients worldwide." to the MOON and BACK

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