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89 EW CORNEA September 2017 effective, and stable, there would be few barriers to more widespread adoption of this technique; donor corneal tissue is easily obtained and can easily be cut to the proper dimensions using available instruments. Creating corneal channels can be done with almost any femtosecond laser, and the remaining instrumentation is commonly available. I look forward to hearing more from Dr. Jacob about her success with this technique. Editors' note: Dr. Hovanesian has fi- nancial interests with Shire (Lexington, Massachusetts), Tear Film Innovations (San Diego), and TearScience. Contact information Hovanesian: johnhova@gmail.com understand why younger and younger patients are manifesting with dry eyes signs, but this study objectively demon- strates how common the precursor conditions to dry eye actually are in asymptomatic patients. When we have a new metric, like meibomian gland imaging, we need to define population normals and learn more about the correlation between findings and actual disease. This study gives us much to think about, and I look forward to hearing more about the epidemiology of gland anomalies in the healthy population. Corneal allogenic intrastromal ring segments for the treatment of keratoconus Soosan Jacob, FRCS, MS, Athiya Agarwal, MD Purpose: To describe a new technique of corneal allogenic intrastromal ring segments (CAIRS). Methods: This prospective interven- tional case series was carried out at a tertiary care eye center (Dr. Agarw- al's Eye Hospital, Chennai, India). It included 14 patients of keratoconus who underwent implantation of the new allogenic intracorneal ring segments. The allogenic implant was prepared from a donor cor- neo-scleral rim. Implantation was followed by collagen crosslinking in all patients. Results: There was a significant decrease in the steepest keratometry and improvement in uncorrected and best corrected visual acuity. A satisfactory demarcation line was seen in all patients. None of the patients showed progression. No complications were seen in any patient. Conclusion: CAIRS is an effective treatment strategy for improving corneal topography and visual qual- ity in patients with keratoconus by acting as a spacer graft. It has advan- tages of avoiding synthetic tissue in the cornea. EW Dr. Hovanesian: I found the technique described in this paper to be elegant and innovative. Though it shares some com- monality with keratophakia, a proce- dure that has not had high success, this technique of using donor corneal tissue as a corneal ring segment in ectasia has shown promising early results. Maybe it has been successful because the tissue added is in the peripheral cornea, and the precise thickness and orientation of the implanted corneal stroma does not matter as much as in keratophakia. Furthermore, if it proves to be safe, atrophy, grade 3 showing 51–75% atrophy, and grade 4 >75% gland atrophy, and grading of MG tortuos- ity on a 3-point scale. Results: 98 eyes total were imaged; five were excluded due to poor image quality. Out of 93 eyes, 51 (55%) had evidence of MG atro- phy, and 34 (37%) had evidence of MG tortuosity. When evaluated by gland atrophy score, 38 eyes (41%) had grade 1 atrophy, 12 eyes (13%) had grade 2 atrophy, and one eye (1%) had grade 3 atrophy. Of those with MG atrophy, 25% had prior eye surgery, with strabismus surgery being the most common procedure. No significant association was found between history of prior eye sur- gery and presence of gland atrophy (p=0.92) nor between gender and MG atrophy (p=0.1846) in this study population. Of those with gland atrophy, only 7% had symptoms of dry eye with SPEED scores of 2–4. Conclusion: This study describes for the first time the prevalence of MG atrophy among a pediatric popu- lation. More than half of the eyes examined demonstrated some form of MG atrophy, despite young age. While the pediatric population stud- ied may over-represent those at an increased risk for MG dysfunction, these findings indicate a need for additional research. Dr. Hovanesian: Our collective thinking about dry eye has evolved significantly in recent years, and we now think of this disease in much the same way as we do glaucoma—asymptomat- ic patients with early disease need management to prevent a predictable progression to vision-threatening complications. Our science does not yet Cornea Watch a video of Dr. Hovanesian's presentation on EyeWorldAR Download the EyeWorldAR app and scan this EWAR code Source: John Hovanesian, MD

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