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EW MEETING REPORTER 68 January 2015 Reporting from the 4th Asia Cornea Society Scientific Meeting Taipei, Taiwan, Dec. 11–12, 2014 practical, clinical therapies, he said that others should take the cue from their research and think outside the box to find other alternatives. Corneal structure insights from DALK Discussing what deep anterior lamellar keratoplasty (DALK) has taught us about the corneal struc- ture, Sadeer Hannush, MD, Phil- adelphia, said that for the first few years that surgeons were performing DALK, "we believed we were look- ing at Descemet's membrane. We now know it is the pre-Descemet's layer"—dubbed Dua's layer after its discoverer, Harminder Dua, MD, Nottingham, U.K. The clinical implication of the discovery is that when performing the Anwar "big bubble" technique, surgeons might find themselves creating 1 of 2 types of big bubble: Type 1 bubbles form when air is injected anterior to Dua's layer. These bubbles form from the center, extending outward to the periphery, and are robust enough for blunt instruments to bounce off of them. Type 2 bubbles form when air is injected posterior to the layer. These bubbles extend from the periphery to the center. Type 2 bubbles are delicate and can easily burst into the anterior chamber. When a type 2 big bubble is created, Dr. Hannush said that the surgeon should proceed more care- fully, though the DALK can still be In a clinical trial involving 115 patients followed for 6 months, Dr. Pan found porcine corneas have similar physiological parameters with human corneas. He concluded that dehydrated pig lamellar transplants might be an option for corneal transplantation, with corticosteroids reducing rejec- tion, the main remaining obstacle being infection. Jae-Yong Kim, MD, Seoul, South Korea, studied the feasibility of the use of "Sub-Tenon's Triamcin- olone Injection to Prevent Rejection after Penetrating Keratoplasty." Tri- amcinolone has similar anti-inflam- matory effects as other agents, but has a longer duration of action. In 119 eyes of 89 patients, 25 of whom were graft failures, they in- jected 8 mg/0.2 ml of triamcinolone into the inferior sub-Tenon's space through a 26-gauge needle. Kaplan- Meier survival analysis revealed a statistically significant improvement in graft survival (P=0.02). The main complications were increased IOP and epithelial defect. Dr. Kim concluded that post-PK sub-Tenon's triamcinolone injec- tions "could be helpful" and that aggressive IOP control post-PK was protective in these cases. Hyung Keun Lee, MD, Seoul, investigated "Molecular Targets and Immunomodulatory Drugs for Preventing Corneal Allograft Rejec- tion." In particular, Dr. Lee and his colleagues investigated the develop- ment of the decoy receptor D6—an atypical, "scavenging" receptor that does not transduce the inflamma- tory cascade and binds more than 20 different chemokines—into a D6 mimicking trap (D6MT) as an aid for graft survival. Dr. Lee concluded that D6 expression correlated with graft survival and that D6MT can be used to reduce the incidence of graft rejection. The cutting edge in corneal regenerative medicine Shigeru Kinoshita, MD, Kyoto, Japan, and colleagues continue to investigate what they think could be a future option for corneal endothelial therapy. They proposed the use of injections of cultivated corneal endothelial cells (CECs) for the treatment of advanced endo- thelial dysfunction and Rho kinase (ROCK) inhibitor Y-27632 eye drops for early stages. Whereas old donor corneas are used for keratoplasty procedures, Dr. Kinoshita said that young donors can be used to cultivate CECs. More- over, one donor can potentially be used for 100 patients. The protocol they use for cul- tivating CECs involves the use of ROCK inhibitor to promote prolif- eration. Epithelial-mesenchymal transformation (EMT) is limited by the use of mesenchymal stem cell condition media (MSC-CM). To date, they have injected cultivated CECs into 9 patients, in- cluding cases of bullous keratopathy and Fuchs' dystrophy. Meanwhile, Dr. Kinoshita and his colleagues have investigated the use of ROCK inhibitor eye drops to treat 8 cases. One case of an 84-year-old female with accidental Descemet's membrane removal after cataract surgery who began with count- ing fingers vision progressed to a visual acuity of 0.8 at 11 weeks with treatment with ROCK inhibitor eye drops. At 1 month, the cells could be seen attached to the posterior surface of the cornea even without the Descemet's membrane, and by 6 months the cells resembled CECs. While Dr. Kinoshita admits their work might not necessarily lead to View it now: ACS 2014 ... EWrePlay.org Matthew Feng, MD, discusses the transition from DMEK to DSEK for new surgeons who have trained in DMEK. PREVIEW PROGRAM CorneaCongress.org Sponsored by NEW IN 2015! SIMULTANEOUS ENGLISH–SPANISH LANGUAGE TRANSLATION TRADUCCIÓN SIMULTÁNEA DE INGLÉS A ESPAÑOL WCC VII Preview Program now online at: digital.CorneaNews.org

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