Eyeworld

EW CORNEA 44 November 2016 Concerns remain Dr. Moloney's primary concern is whether the procedure could com- promise outcomes from any subse- quently needed graft procedure. "There is a limited cohort of patients having a graft after a failed descemetorhexis, and their results need to be followed closely to address this concern," Dr. Moloney said. Secondarily, Dr. Moloney is concerned that the procedure will be attempted indiscriminately. He not- ed that "patient selection is critical to success." Dr. Moloney and colleagues have had success with the proce- dure in patients ranging from 38 years old to 84 years old. However, they think success is more likely in younger patients, due to in vitro studies demonstrating increased physical reserve and capacity for mitosis in younger patients. Patient selection To test which patients may have success with this procedure, Dr. Moloney and colleagues closely examined the central and superior cornea with high resolution confo- cal microscopy. "We felt this was most useful in guiding us toward patients with good physical reserve and away from those with poor or diseased periph- eral cells," Dr. Moloney said. In the future, genetic studies may provide further guidance. So far, such tests only have suggested trends rather than hard rules for case selection. The treatment is intended for FED patients only, Dr. Moloney noted. "It is not a treatment for pseu- dophakic bullous keratopathy," Dr. Moloney said. "In such cases, any peripheral reserve of cells has been exhausted and cannot provide any healing support for further injury." Dr. Moloney and colleagues spent considerable time on the consent process for their study. The chance of failure from the proce- dure meant patients needed to be symptomatic enough from their condition to otherwise contemplate an endothelial keratoplasty. Patients were told to expect 3 months of healing, and in the first month they would be quite blurry. However, the treated eye was not disabled during that entire time but improved week by week. "The concept of an endothelial keratoplasty is raised as a possibility to salvage non-responding cases," Dr. Moloney said. Combination approach Dr. Colby noted her case series was performed at the end of cataract surgery. "We routinely do cataract sur- gery with endothelial keratoplasty so I did cataract surgery, put the lens in, and stripped the central Descem- et's," Dr. Colby said. "There's no reason you would have to do it with cataract surgery, but most of the people on whom I performed this procedure had a visually significant cataract anyway." EW References 1. Moloney G, et al. Descemetorhexis for Fuchs' dystrophy. Can J Ophthalmol. 2015;50:68–72. 2. Borkar DS, et al. Treatment of Fuchs' endothelial dystrophy by Descemet stripping without endothelial keratoplasty. Cornea. 2016;35:1267–73. Editors' note: Drs. Colby and Moloney have no financial interests related to their comments. Contact information Colby: kcolby@bsd.uchicago.edu Moloney: gregorymoloney@yahoo.com.au Positive continued from page 42 Join the largest subspecialty society representing the fields of cornea and external disease. Member Benefits • Cornea: The Journal of Cornea and External Disease • Annual Meetings: Select discounted registration at membership events and educational programs • VideoEd: A weekly broadcast of clinical videos recorded live at national and international cornea meetings • Kera-net: The online forum for the exchange of clinical and scientific information • Cornea Society News: Quarterly newsletter sent to all Society members CorneaSociety.org Save the Date July 8-9, 2020 World Cornea Congress VIII Singapore2020 corneacongress.org/2020

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