Eyeworld

129 EW CORNEA October 2016 by Maxine Lipner EyeWorld Senior Contributing Writer Finessing Fuchs' A novel procedure may reduce the need for transplants F or patients with Fuchs' endothelial dystrophy, a new procedure may help clear the cornea without the need for transplantation of foreign cells. Results published in Cornea indicate that in about 75% of cases the technique, known as Descemet's stripping without endo- thelial replacement, was successful. This novel technique is a de- parture from the current standard of care of corneal transplant, which requires use of foreign cells, accord- ing to Kathryn Colby, MD, PhD, Louis Block Professor and chairman, Department of Ophthalmology and Visual Science, University of Chicago. With the transplantation of foreign cells comes the need for continued topical steroid use with potential side effects such as cata- ract formation, a rise in IOP, and a predisposition to infection, Dr. Colby noted. "Corneal tissue is also quite expensive and availability is limited in some areas of the world," she said. With the new technique, 4 mm of both the central endothelium and the Descemet's membrane are re- moved. "It's similar to the first step of the normal endothelial kerato- plasty in which the anterior cornea is marked to indicate the amount of endothelium and Descemet's to be removed. Then I use a reverse Sinskey hook to score the tissue and physically remove it from the eye," Dr. Colby explained. "That's identi- cal to the initial stages of DSEK and DMEK," she said, adding that the idea is to allow the patient's own re- maining peripheral endothelial cells to cover the newly created defect rather than transplanting foreign tissue. Studying the technique In the retrospective case series, investigators considered how 11 Fuchs' dystrophy patients on whom Dr. Colby performed the Descem- et's stripping procedure fared. The procedure was performed on 13 eyes, with patients who ranged in age from 51 to 91. All underwent the procedure in conjunction with phacoemulsification. After first inserting an IOL, a 4 mm area of the central Descemet's membrane was stripped. Investigators found that in most cases, patients will respond to the procedure. "The peripheral endothe- lial cells repopulated the central cor- nea in about 75% of people in our series," Dr. Colby said, adding that these are healthier cells that have no guttae. "In patients in whom the technique works, the cornea clears and thins. These are their own continued on page 130

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