Eyeworld

EW FEATURE 74 World Cornea Congress highlights September 2015 together in a distinct anatomic category. TGFBI mutations affect multiple layers of the cornea, so these dystrophies had been grouped separately depending on the layer affected despite the fact that they come from the same gene. The authors also described a category of dystrophies that were previously not well recognized— epithelial recurrent erosion dystrophies. The 3 variants of this disease are inherited as autosomal dominant disorders and present in the first decades of life with recur- rent epithelial erosions. During the pain-free periods, corneal exams are normal, but by midlife, patients may have subepithelial corneal fibrosis or corneal keloid. "These hereditary conditions can be an under recognized cause for recurrent corneal erosions," Dr. Weiss said. The IC3D Edition 2 is available for free online to be used as an easy reference for comprehensive ophthalmologists. The prior edition is available online at www.cornea- society.org in English, Spanish, and German. Disease templates now in- clude specifics about histopathology, OCT and/or confocal microscopy, fingers in the first year of life, you exponentially improve their global development rather than just their visual development," he said. Rather than treating these opacities as if they were in adult cor- neas, Dr. Nischal urged physicians to recognize that these infants and children are still developing biolog- ically and their brains have huge potential for compensation. Even if a graft is rejected, poor vision is better than none. "The brain is a blank canvas," Dr. Nischal said. "If you leave it blank, it's not going to do very well. But if you give it some information, it will utilize that information to its maximum potential." Redefining corneal dystrophies Recent advances in DNA sequenc- ing and improved histology and microscopy techniques have given physicians a better understanding of the genetic and cellular origins of corneal dystrophies. Using this information, cornea specialists have regrouped these conditions into a new classification system. The International Committee for Clas- sification of Corneal Dystrophies (IC3D), Edition 2, was published in the February 2015 issue of the journal Cornea. Jayne S. Weiss, MD, chair of the Department of Ophthalmology, Louisiana State University Medical School, New Orleans, the paper's lead author, presented the new IC3D to attendees during the session. "We now recognize that some corneal dystrophies affect many cell layers, and this is reflected in the new anatomic classification," Dr. Weiss said. Dr. Weiss and her collaborators updated the IC3D to include the major clinical, histopathologic, and genetic information that has been learned since the first edition was published in 2008. They reclassified corneal dystrophies into 4 groups based on corneal anatomy—epitheli- al and subepithelial dystrophies, ep- ithelial-stromal dystrophies caused by mutations in the transforming growth factor, beta-induced gene (TGFBI), stromal dystrophies, and endothelial dystrophies. The IC3D Edition 2 is the first to group the TGFBI dystrophies New approaches continued from page 72

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