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EW CORNEA 32 August 2014 Bennie H. Jeng, MD, highlighted the best cornea papers at the "Hot Off the Press" session at the 2014 ASCRS•ASOA Symposium & Congress. The papers were chosen from the Best Paper of Session winners. Here are the abstracts from the studies, with his comments regarding selection. Mid-stromal isolated Bowman layer graft to reduce and stabilize advanced keratoconus and to postpone or prevent penetrating or deep anterior lamellar keratoplasty Jack Parker, MD, and colleagues Purpose: To evaluate the efficacy of Bowman layer implantation in reducing and stabilizing corneal ectasia in patients with progressive, advanced keratoconus (AKC). Design: Prospective, non- randomized clinical study. Setting: Tertiary referral center. Participants: Ten eyes of 9 patients with progressive AKC. Interventions: A mid-stromal manual dissection was made and a donor isolated Bowman layer was positioned into the stromal pocket. Main outcome measures: Before and up to 24 months after surgery (mean follow-up 16 (±5) months), best spectacle corrected visual acuity (BSCVA), best contact lens corrected visual acuity (BCLVA), Pentacam measurements, endothelial cell density (ECD), biomicroscopy, refraction and intra- and postopera- tive complications were recorded. Results: All surgeries were unevent- ful, and throughout the study period no complications related to stromal dissection and/or isolated Bowman layer implantation were observed. Maximum corneal power decreased on average from 74.5 D (±7.1 D) preoperatively to 68.3 D (±5.6 D) (P=0.00). Six of 9 eyes (67%) reached a final BCLVA of ≥20/40 (0.5); 1 eye had low visual potential. No signif- icant changes in BCLVA (P=0.77) or pachymetry (P=0.11) were found; BSCVA improved (n=4) or remained stable (n=5). Conclusion: Isolated Bowman layer implantation may be a safe and effective new technique to reduce and stabilize ectasia in eyes with AKC, potentially allowing long-term contact lens wear. The low risk of complications may allow postpon- ing penetrating or deep anterior lamellar keratoplasty in cases with contact intolerance and/or corneal scarring. Dr. Jeng: For patients with advanced keratoconus who have suboptimal visual acuity and are contact lens intolerant, treatment options are limited, and they usually require either deep anterior lamellar or penetrating keratoplasty. In this paper, the au- thors described their results with using Bowman layer grafting to treat such patients who were not candidates for collagen crosslinking or intracorneal ring segments. In 10 eyes of 9 patients, the authors implanted Bowman layer grafts in the mid-stroma and followed the patients for up to 24 months. They demonstrated, in this series of patients, that the procedure was able to stabilize and also reduce the steepness of the corneas, restoring contact lens tolerance without loss of best corrected visual acuity. This is an important study as it potentially allows for another option for patients with advanced keratoco- nus, avoiding the complications that could be associated with deep anterior lamellar or penetrating keratoplasty. Though it is a small series of patients, the results are encouraging. Descemet's rejection index: novel index for diagnosis of corneal graft rejection Mohamed Abou Shousha, MD, and colleagues Purpose: To evaluate the use of De- scemet's rejection index (DRI) in the diagnosis of corneal graft rejection. Methods: Seventy-one eyes: 27 functional grafts, 9 actively reject- ing grafts, 9 rejected grafts, 7 failed grafts secondary to non-immuno- logical causes and 19 age-matched control eyes were imaged using spectral domain optical coherence tomography. Descemet's membrane thickness (DMT) and host central corneal thicknesses (CCT) were mea- sured. Descemet's rejection index (DRI) was formulated to isolate the Hot off the press: Second in a series of 5 presentations Dr. Jeng highlights the best cornea papers at the "Hot Off the Press" session. Source: EyeWorld Scan to watch video!