EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW MEETING REPORTER 74 May 2015 Reporting from World Cornea Congress VII, April 15–17, 2015 San Diego Reporting from World Cornea Congress VII Endothelial keratoplasty 'amazing' Francis W. Price Jr., MD, India- napolis, is known for positioning his practice at the very forefront of endothelial keratoplasty. In his keynote lecture on the subject at the "Techniques and Technologies for Endothelial Keratoplasty" session at World Cornea Congress (WCC) VII, Dr. Price discussed the evolution of the procedure, beginning with a concise examination of its history, through to new perspectives from current practice and research, and on to a brief look at the procedure's future. As endothelial keratoplasty (EK) has evolved, "we've gotten more precise," he said. This sums up a fundamental aspect of the proce- dure's technical development over the years. In the broadest sense, this precision translates into the defining difference between PK and EK—i.e., the specificity of the tissue being transplanted, from a full-thickness graft to selective, more and more specific lamellar ones Early attempts at the procedure failed due to the use of sutures—the sutures simply did not work with the cornea's curved architecture, ultimately pulling through and com- ing out the back of the donor tissue. The "big insight," Dr. Price said, came in 1998, when Gerrit Melles, MD, PhD, Rotterdam, the Nether- lands, injected air under the donor. Dr. Melles found there was no need for sutures: By stripping the Descem- et's membrane, the donor would simply stick to the posterior surface of the cornea. The procedure, Dr. Price said, "really took off from there." In these early versions of EK, however, the donor tissue was dis- sected manually, resulting in uneven grafts and equally uneven results. Mark Gorovoy, MD, Fort Myers, Fla., then had the idea of using the microkeratome instead of hand dis- section to create the donor graft— hence, the next iteration, Descemet's stripping automated endothelial keratoplasty (DSAEK). Following the procedure's evolution toward lamellar specificity has logically brought about its latest iteration—Descemet's membrane endothelial keratoplasty (DMEK). Due to the thinness of the graft, it is commonly thought by surgeons that the limiting step of this procedure is donor preparation. Dr. Price called this a myth, saying that surgeon-prepared tissue resulted in less than 1% donor loss. The true limiting step, he said, is manipulating and positioning the graft intraoperatively—which, he pointed out, is the fun of being a cornea surgeon. Looking toward the future, Dr. Price cited Shigeru Kinoshita, MD, in Japan, who is working on cell cultures that may be injected or implanted through grafts, or using agents such as Rho-kinase inhibitor, either injected or administered as topical drops, to stimulate regrowth of the endothelium. Freelusion, the world's first 3D dance troup , performs at the World Cornea Congress VII opening ceremony. caption goes here Supported by