Eyeworld

EW MEETING REPORTER 110 February 2017 keratoplasty (DSAEK), ultra-thin DSAEK, pre-Descemet's endothelial keratoplasty (PDEK), and Descemet's membrane endothelial keratoplasty (DMEK). DSAEK has been great, she said. There have been some advances, particularly in tissue preparation and moving toward thinner tissue. Graft insertion techniques have also helped to decrease endothelial trau- ma. This is an additive surgery, Dr. Farid said, so tissue is being added. There is also a hyperopic shift in the optics of the eye. Meanwhile, DMEK is a replace- ment surgery, so there's not much of a hyperopic shift. There were some early issues with DMEK involving upside down grafts, detachments, and failure, but many improvements have been made to address these problems. For graft insertion, there are no-touch glass tube injectors. The S-stamp helps eliminate the risk of upside down grafts, and 20% SF6 gas helps to decrease rebubbling and early postoperative detachments. Dr. Farid directly compared DSAEK and DMEK. DSAEK is an additive procedure with a 4–5 mm incision. Meanwhile DMEK is a substitution with a 3 mm incision. DSAEK involves a thicker cornea graft and hyperopic shift, while DMEK features anatomic replace- ments with no refractive shift. Graft her patients eat a variety of fruits and vegetables, especially green leafy vegetables, and she suggests coffee with caffeine in moderation. Editors' note: Dr. Schuman has no financial interests related to his comments. Dr. Singh has financial interests with Aerie Pharmaceuticals (Bedminster, New Jersey), Alcon, Aller- gan, ForSight VISION5 (Menlo Park, California), InnFocus (Miami), Ivantis (Irvine, California), Shire (Lexington, Massachusetts), and Transcend Medical (Menlo Park, California). Dr. Ou has no financial interests related to her comments. Updates in endothelial keratoplasty Marjan Farid, MD, Irvine, Califor- nia, highlighted some of the updates in endothelial keratoplasty. Over the past decade or so there has been a tremendous shift in the type of tissue eye banks provide, she said. In 2005, most were penetrating kerato- plasty (PK), but in 2015, more than a third were endothelial keratoplasty (EK), Dr. Farid said. "There's defi- nitely been a push toward thinner grafts," she said. Thinner grafts tend to have faster visual recovery and optical quality. However, surgical challenges have also increased. Dr. Farid spoke about Descem- et's stripping automated endothelial and using aggressive therapy for fast progressors. Joel Schuman, MD, New York, discussed topics in regenerative ophthalmology, highlighting a developing approach for whole eye transplantation. This would be total human eye allotransplantation with the entire optical system, including viable ocular tissue with ganglion cells and photoreceptors. However, there are a number of obstacles that could make this difficult, including the difficulty of ensuring adequate blood supply to the transplanted eye, the question of immune rejec- tion of ocular tissue, and failure of optic nerve regeneration. Dr. Schuman spoke about current tests of this technique on rats that have been showing success. These tests have allowed researchers to start to develop a technique for transplant moving forward. "We have established a reliable orthot- opic vascularized whole eye trans- plantation model in rats, which is the first in the world," he said. Gross morphology, viability, structural in- tegrity, and aqueous humor dynam- ics are relatively maintained. This approach is ideal for studying the viability, function- al return, central nervous system reintegration, and immune response after whole eye transplantation. Dr. Schuman added that there is high-quality data in carefully controlled experiments, low-cost reproducible experiments, and high throughput testing to identify interventions to bring forward for preclinical studies. Yvonne Ou, MD, San Francisco, shared some insights about life- style modifications and glaucoma and what she recommends to her patients. First, she discussed exercise and said that studies have shown that the effect of exercise on IOP reduction is greater in those with a sedentary vs. an active lifestyle. Dr. Ou tells her patients to "get mov- ing," especially if they aren't already. She also discussed yoga and body position. Inverted head poses tran- siently increase IOP, but how this truly affects glaucoma progression is unknown. Dr. Ou recommends that View videos from Hawaiian Eye 2017: EWrePlay.org Terry Kim, MD, discusses the importance of early diagnosis and intervention in managing retained lens fragments following cataract surgery. Reporting from Hawaiian Eye 2017, January 14–20, Kauai, Hawaii Sponsored by

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