Eyeworld

I t was not too long ago that the most exciting breakthrough in keratoplasty techniques dis- cussed at meetings or in journals was a new su- turing pattern for a penetrating keratoplasty (PK). For several decades, the corneal surgeon performed a PK for almost all corneal pathology. We had lively debates on wound construction and run- ning versus interrupted sutures. If we really got crazy, we did a combination running and interrupted, or a double running suture. As it turns out, we were a boring lot. But look at the cornea specialist now. In a few short years, we have relegated the PK procedure to a small minority of cases performed. What has oc- curred in corneal transplantation is a relatively rapid transition to tissue-targeted surgery. These new procedures utilize excision of the pathologic layer and leave normal tissue untouched. We now talk about endothelial keratoplasty for endothelial disease, anterior lamellar kerato- plasty for stromal disease, and ocular surface transplantation for epithelial stem cell deficiency. In this issue of EyeWorld you will read about the latest techniques in lamellar corneal surgery—DSEK, DMEK, DALK, FAPK, FALK, and the ways we can improve on these relatively new techniques. Can we protect the en- dothelial cells better with new insertion techniques in DSEK? Will DMEK give such superior visual results over DSEK that we should embrace this tech- nique? How can we make the DALK procedure less time-consuming, and how do we reduce the rate of perforation of Descemet's membrane? Will the femtosecond laser ultimately be better than the trephine and the keratome to cut both the donor and the recipient cornea in all lamellar surgery? If so, who will pay for it? You will also see that we are still discussing the PK procedure. However, PK is usually mentioned with the new techniques associated with the fem- tosecond laser (femtosecond-assisted penetrating keratoplasty—FAPK). The femtosecond laser allows for more symmetric wound construction, stronger wounds, faster visual rehabilitation, and potentially less astigmatism. Also in this issue is a story about the improvements in the biosynthetic cornea. This bioengineered cornea has been used clinically in patients and has been found to support the in-growth of endogenous cells and nerves. If this technology works, mass production of the device could go a long way in treating the 10 million individuals worldwide who are blind due to corneal disease. It has been a rapid transition for the corneal surgeon to go from being a one-trick pony to a wild rodeo. I have a feeling that this is just the start and many new innovations in corneal surgery lie ahead. EW NEWS & OPINION 9 May 2011 Edward Holland, M.D. Professor of ophthalmology, University of Cincinnati Publisher Donald R. Long dlong@eyeworld.org Editorial Editor Stephanie Graham stephanie@eyeworld.org Assistant Editor Stacy Majewicz smajewicz@eyeworld.org EyeWorld Staff Writers Faith Hayden faith@eyeworld.org Jena Passut jena@eyeworld.org Production Graphic Designer Julio Guerrero jguerrero@eyeworld.org Production Manager Cathy Stern cstern@eyeworld.org 703-383-5702 Production Assistant Karen Salerni ksalerni@eyeworld.org Contributing Editors Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Enette Ngoei Singapore Matt Young Malaysia Senior Contributing Editor Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-273-2963 eyeworld@eyeworld.org www.eyeworld.org Advertising Sales Managers Jeff Brownstein jbrownstein@eyeworld.org 703-788-5745 Paul Zelin pzelin@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cstern@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jdonohoe@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003; telephone: 703-591-2220; fax: 703-273-2963. 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POSTMASTER: Send change of address to EYEWORLD, 4000 Legato Road, Suite 700, Fairfax, VA 22033. Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices. The ideas and opinions expressed in EYEWORLDdo not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G   S T A F F May 2011 Volume 16 • No. 5 A S C R S The official publication of the American Society of Cataract & Refractive Surgery Penetrating keratoplasty: Now you see it, now you don't

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