Eyeworld

Cornea Society News – published quarterly by the Cornea Society 5 It was from outbreaks, he said, that we have learned quite a bit about Acan- thamoeba keratitis. Through outbreaks, we have been able to identify contact lens wear as the primary risk factor, amplified by deviations in water qual- ity; study of these outbreaks suggests that environmental risk factors may not be modifiable; and the surge in Acan- thamoeba keratitis over the last decade or so may reflect changes in risk factors that may have an effect not only on other ocular infections but also on the general public health. Big data, Dr. Tu said, remains most ideal, but small data and even really small data have their value. Ultimately, he concluded, what is important is that whether big, small, or very small, the data be "good and clean" and that their study be directed by knowledge. Cornea surgery begins in the eye bank "It used to be that corneal surgery was quite straightforward," said Marian Macsai, MD, Glenview, Illinois. "We had a problem—keratoconus—we got a cor- nea, we punched a button, we sewed it into place, and the eye was rehabilitated. "Things have gotten much more complicated in the past decade," she said. Corneal transplantation is no lon- ger restricted to full-thickness penetrat- ing grafts, with surgeons now perform- ing lamellar surgery with partial grafts, sometimes even using scleral tissue for grafts; moreover, rather than being used on the spot, corneal tissue is being stored long term and shipped all around the world. In her plenary lecture, Dr. Macsai made the argument that, following more than 25 years of dramatic surgical inno- vation and advancements in instrumen- tation, today "Corneal Surgery Begins in the Eye Bank." "The processing of tissue is very high level and quite complicated," Dr. Macsai said. It was because of this that the Eye Bank Association of America (EBAA) established universal medical standards for eye banking. The standards cover the six eye banking functions: recovery, processing, storage, evaluation of tissue for trans- plantation, determination of donor eligibility, and distribution. In addition, eye banks provide in- frastructure for gathering postoperative outcome information up to and includ- ing adverse reactions. Given the scope of eye banking and the complexity of modern corne- al transplant surgery, all around the world cornea doctors no longer retrieve or process corneas before surgery, the exception being South Korea, where the law requires that physicians continue to do so. Elsewhere, Dr. Macsai said, the ad- vantages of eye banking are clear. Since surgeons no longer have to worry about harvesting and process- ing tissue, they can perform surgery in a matter of minutes. In DSAEK and DMAEK, for instance, Dr. Macsai said that the surgeon simply grips the Descemet's membrane and inserts the tissue into the AC, injects air or gas, and it is done. Moreover, she said, it is likely that an eye bank technician precutting and processing tissue over and over will be doing it much more efficiently than any surgeon doing it just once or twice a week. Any lingering concerns over the quality of precut tissue should also be laid to rest; Dr. Macsai said that there is no significant difference in the quality of tissue or patient outcomes between surgeon prepared and precut tissue. Overall, precutting also saves time and money, as well as reduces stress in the operating room and the amount of tissue wasted per procedure. There are concerns about ship- ping tissue overseas. However, while one study has shown endothelial cell density (ECD) losses of around 1.75% with precutting and 3.79% with overseas transportation—for a total ECD loss of 5.68%—and another study on 40 donor corneas during international shipment underwent 2.3% ECD loss, Dr. Macsai said that the dislocation and rejection rates were comparable with corneas that stayed local before transplantation. It is true, however, that Dr. Tu has published a study showing that fungal contaminants can be amplified in stor- age media by more than 100 times by routine warming cycles as compared to a single warming cycle, and Dr. Macsai wondered whether antifungal should be added to the storage media. CN Contact information Joo: ckjoo@catholic.ac.kr Karp: ckarp@med.miami.edu Macsai: MMacsai@northshore.org Tu: etu@uic.edu Cornea journal report Cornea, the Cornea Society's journal, has added several members to the Edi- torial Board: Claus Cursiefen MD, PhD, is ophthalmology chair in Cologne, Germany, and an expert in corneal neovascularization and transplant surgery; Esen Akpek MD, from the Wilmer Eye Institute, Johns Hopkins University, specializes in ocular surface disease; Sophie Deng, MD, PhD, studies ocular surface transplantation at the Stein Eye institute of UCLA; and Bennie Jeng, MD, is chair of ophthalmology at the University of Maryland and an expert on eye banking. We welcome their added expertise. Vincent DeLuise, MD, has retired as assistant editor after many years of service improving the science and the linguistics of our manuscripts. Kazuo Tsubota, MD, is taking a leave of absence from the board to pursue an execu- tive MBA degree. Both have provided outstanding contributions to the journal and to the Cornea Society. Kenneth Kenyon, MD, and Chris Rapuano, MD, have moved to positions as assistant editors of the journal. I am certain that continuing change will help us keep up with the continu- ing progress of our field and the growing activity of the journal. I greatly appre- ciate the contributions of all of our board members, authors, and reviewers. —Alan Sugar, MD, editor-in-chief

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