EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/422211
EW CORNEA 58 December 2014 by Ellen Stodola EyeWorld Staff Writer Endothelial keratoplasty, keratoprosthesis, and PK offerings Sessions at the World Cornea Congress in San Diego will focus on hot topics in the cornea field T he World Cornea Congress, prior to the 2015 ASCRS•ASOA Symposium & Congress in San Diego, will feature a number of interesting sessions focusing on the cornea subspecialty. These will include the "Techniques and Technologies for Endothelial Keratoplasty" session, which Terry Kim, MD, professor of ophthalmol- ogy, Duke University Eye Center, Durham, N.C., will moderate. Francis W. Price, MD, PhD, Indianapolis, will give the keynote of that session on "The Evolution of Endothelial Keratoplasty: Where Are We Headed?" Endothelial keratoplasty offerings This topic is a big area in corneal transplantation right now, Dr. Kim said. The World Cornea Congress is designed differently from sub- specialty Cornea Day, which occurs each year prior to the ASCRS•ASOA Symposium & Congress. The World Cornea Congress occurs only once every 5 years. Cornea Day is designed for cornea specialists and general ophthalmologists alike so they can go back to their practices with some pearls. "World Cornea Congress is different because now we're get- ting more of a scientific and global perspective on issues like corneal transplantation," he said. There are more talks on the academic and evidence-based level, Dr. Kim said. "I think the audience will get some practical pearls, but in general the lecture topics are going to be broader in nature and more international in scope. "The World Cornea Congress is sponsored by the Cornea Society and has a very informative program that highlights the tremendous advances and progress that have been taking place in the cornea field from both clinical and research en- deavors. This comprehensive 3-day meeting includes invited speaker, free paper, and poster sessions, and it continues to draw a huge domestic and international audience who are looking to hear and learn the latest and greatest in cornea," Dr. Kim said. The endokeratoplasty session that Dr. Kim will moderate covers controversial, practical, and thought-provoking issues in both Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK). For the DSEK section, topics include the effect of graft thickness on visual outcomes in DSEK presented by Sanjay V. Patel, MD, DSEK surgery in complex eyes presented by Kenneth M. Goins, MD, and the optics of posterior lamellar grafts presented by Jesper Hjortdal, MD. The section on DMEK covers DMEK graft and recipient preparation techniques presented by Frederick E. Kruse, MD, surgical strategies to reduce complication rates presented by Nicolas C. Pereira, MD, the role and rationale for pre-Descemet's endothelial keratoplasty (PDEK) presented by Amar Agarwal, MS, FRCS, FRCOphth, and Descemet's membrane endothelial transfer surgery presented by Gerrit Melles, MD. Dr. Kim said he is interested to hear the keynote from Dr. Price. He is curious about the issue of whether thin DSEK is worth considering as opposed to transitioning completely to DMEK, especially because many corneal surgeons are still actively performing DSEK because of the lower complication rate and shorter surgery time. Dr. Price said there has been a huge revolution recently in corneal surgeries. "The last 10 years have been extremely exciting in cornea because corneal surgeries, as far as transplants go, haven't really changed for 30 or 40 years," he said. The biggest change in the U.S. has been with endothelial kerato- plasty, he said, where surgeons are transplanting just Descemet's and endothelium. Meanwhile, DSEK and Descemet's stripping automated endothelial keratoplasty (DSAEK) still use stroma, but the amount is getting continually smaller. "The reason this has been so exciting is it's safer for the patient using smaller incisions," he said. "We get tremendously better vision that correlates with how thin the tissue is, and what was not suspected is that the rejection rates fall." These changes have resulted in better outcomes for patients. Visual results with DMEK are similar to cataract surgery, both predictable and quick, Dr. Price said. "In the next 10 years, I think we need to find better ways to do our corneal endothelial procedures in eyes with glaucoma," he said. "Glaucoma will be a huge cause for corneal transplants in the next 10 years." Most glaucoma procedures can cause damage to the cornea. "There are multiple centers around the world that are doing research into regenerative treatments for the cor- neal endothelium or transplanting endothelial cells alone," Dr. Price said. He expects a lot of research looking into this in the next decade. "I think this World Cornea Congress is going to be huge because [this area] is changing so fast," he said. Whether it is the way surgeons do transplants, reshaping the cornea for refractive surgery, or using SMILE (small incision lamellar extraction, Carl Zeiss Meditec, Jena, Germany), many exciting innovations are happening, Dr. Price said. Keratoprosthesis and PK In the session on "Keratoprosthesis and Penetrating Keratoplasty," Kathryn Colby, MD, PhD, will serve as moderator, with Roberto Pineda, MD, giving the keynote on "Corneal Transplantation in the Developing World: Lessons Learned." Dr. Colby said that a number of talks in this session will address interesting issues with keratoplasty. Dr. Pineda has done a tremendous amount of international mission work, performing corneal surgery and setting up a keratoprosthesis program in several countries, includ- ing Ethiopia and Sudan, she said. "I think his experiences over the decades of mission work will be both inspirational and enlightening for people attending the session." Another talk will compare the long-term outcomes of repeat penetrating keratoplasty (PK) versus keratoprosthesis. For cornea spe- cialists who deal with complicated cases, there is always the question of what to do after someone has had 3 or 4 failed keratoplasties, Dr. Colby said. This presentation will look at a patient population for outcomes and complications. The talk by Mona Dagher, MD, will be important as well, Dr. Colby said. As outcomes with keratopros- thesis improve, more are being implanted; the main problem with long-term preservation of vision is progression of glaucoma. This talk looks at a large patient population and should give additional insights into why people lose vision to glaucoma long-term with the Boston KPro (developed at Massachusetts Eye and Ear Infirmary), she said. Dr. Colby is interested in the presentation by Juan Carlos Abad, MD. He has been using oversized back plates for the KPro, which Dr. Colby also uses. It does appear that there is less retroprosthetic membrane formation using an oversized back plate. "While glaucoma is the com- plication that is most devastating in terms of vision, retroprosthetic membrane formation is the most common complication after Boston KPro implantation," Dr. Colby said. "Any strategies that we can use to reduce its occurrence will be very helpful to KPro surgeons around the world." EW Editors' note: Drs. Colby, Kim, and Price have no financial interests related to their comments. Contact information Colby: kacolby@meei.harvard.edu Kim: terry.kim@duke.edu Price: francisprice@pricevisiongroup.net World Cornea Congress preview