Eyeworld

97 EW CORNEA September 2017 Moloney et al. also pointed out that even successful cases in the long term might prove temporary with grafting needed. For now, Dr. Moloney said new patients with Fuchs' coming to his practice will be assessed clinically and with confocal microscopy for a view of their whole endothelial mo- saic. He said he would recommend the Descemetorhexis technique for patients with dense central guttata, producing visually significant symp- toms, with a clear peripheral cornea. There needs to be a healthy endo- thelial cell count and cell morpholo- gy in the peripheral cornea. "Corneal pachymetry is a useful surrogate of endothelial health in these patients, with thickness >620 of concern," Dr. Moloney said. He also said patients must be able to provide informed consent and be informed that there is a 20% failure rate that might require use of rescue measures like topical ripasudil or endothelial keratoplasty. If a patient has guttata limbus to limbus, peripheral cell counts <1,000/mm 2 , dense edema, or thick pachymetry, Dr. Moloney said he recommends Descemet's membrane endothelial keratoplasty (DMEK). Ultimately, Dr. Moloney thinks Descemetorhexis without a graft has the potential to become a first-line surgical treatment for a subset of Fuchs' patients, but he added, "we will always need DMEK surgery for situations of low cell counts." EW References 1. Moloney G, et al. Descemetorhexis without grafting for Fuchs' endothelial dystrophy–sup- plementation with topical ripasudil. Cornea. 2017;36:642–48. 2. Balachandran C, et al. Spontaneous corneal clearance despite graft detachment in Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2009;148:227–234. 3. Moloney G, et al. Descemetorhexis for Fuchs' dystrophy. Can J Ophthalmol. 2015;50:68–72. 4. Galvis V, et al. Descemetorhexis without endothelial graft in Fuchs' dystrophy. Cornea. 2016;35:e26–8. 5. Arbelaez JG, et al. Long-term follow-up and complications of stripping Descemet membrane without placement of graft in eyes with Fuchs' endothelial dystrophy. Cornea. 2014;33:1295–9. 6. Koenig SB. Planned Descemetorhexis without endothelial keratoplasty in eyes with Fuchs' corneal endothelial dystrophy. Cornea. 2015;34:1149–51. 7. Okumara N, et al. Effect of the Rho-asso- ciated kinase inhibitor eye drop (ripasudil) on corneal endothelial wound healing. Invest Ophthalmol Vis Sci. 2016;57:1284–92. 888-myLENSTAR myLENSTAR.com © 2016 Haag-Streit USA. All Rights Reserved. Now you can optimize both outcomes and workflow. Fully integrated into Lenstar's proprietary EyeSuite software at no additional charge, the ground-breaking Hill-RBF approach to IOL calculation uses advanced pattern recognition, data interpolation and a validating boundary model to substantially improve IOL power prediction, with minimal refractive surprises. Lenstar + Hill-RBF. True accuracy. Confidence. And now, convenience. Learn more today at mylenstar.com. LENSTAR IS THE WORLD'S ONLY BIOMETER WITH THE HILL-RBF METHOD BUILT IN. Contact information Moloney: gregorymoloney@yahoo.com.au Editors' note: Dr. Moloney has no financial interests related to his comments.

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