EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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106 EW MEETING REPORTER October 2012 Reporting live from ESCRS 2012 Milan, Italy XXX Congress of the ESCRS welcomes attendees to Milan Perfecting crosslinking Transepithelial crosslinking works, but the best UVA-riboflavin formula to use is still in question, according to one of the pioneers of the proce- dure, who spoke during the second day of EUCornea, immediately pre- ceding the European Society of Cataract and Refractive Surgeons (ESCRS) meeting in Milan. "The optimal pharmacological formula remains to be found, but hypoosmotic solutions, benzalko- nium chloride (BAC), and other drugs may be involved," said Theo Seiler, M.D., Zurich. New profiles and higher irradi- ance are helping to improve the pro- cedure, causing significant flattening in a high number of keratoconus pa- tients, Prof. Seiler said. This more optimized profile may mean that in- dications for crosslinking may go be- yond progressive keratoconus patients and result in fewer addi- tional PRK treatments, he said. Because the depth of crosslink- ing (CXL) falls off toward the pe- riphery, Prof. Seiler suggested that irradiation with a top-hat profile is not good enough to create a homog- enous CXL effect. Instead, intensity should be increased by at least 25% 3 mm away from the center of the light, he said. Though not every keratoconic patient can adapt to the same surgi- cal approach, George D. Kymionis, M.D., Crete, Greece, said in the same session that simultaneous to- pography-guided PRK followed by CXL appears to be the most promis- ing approach for the best functional vision results. In the past, he said, post-CXL patients were unhappy be- cause their vision had not improved. "We were in a situation where the patients were stable, but they could not see," he said. Advancements in corneal surgery New donor inserters to be used dur- ing Descemet's stripping automated endothelial keratoplasty help im- prove endothelial preservation, mak- ing ultrathin DSAEK with minimal stroma an attractive endothelial re- construction surgery, according to Donald Tan, F.R.C.S., Singapore. The Tan EndoGlide (Network Medical Products, North Yorkshire, U.K.) is ideal for the ultrathin DSAEK procedure, Prof. Tan said dur- ing his talk at the Asia Cornea Soci- ety sponsored session titled "Endothelial cell-based therapies for corneal reconstruction." In response to the challenges of Descemet's membrane endothelial keratoplasty (DMEK) graft insertion, including manipulation and un- scrolling of the donor membrane into the anterior chamber without damaging the endothelium, re- searchers have developed the 50 µm thick D-Mat carrier, a new device that is 9 mm in diameter and shaped like a spatula, which helps support the endothelial graft and lift it into the eye. "Our new approach to DMEK surgery using a disposable mat de- vice also enables us to just trans- plant the DM and the endothelial layer without the stroma," Prof. Tan added. "The donor lamella adheres to the D-Mat surface and does not wrinkle up." Further, advancements in fem- tosecond laser technology, coupled with high-resolution corneal imag- ing, may enhance lamellar corneal surgery as well as stromal lenticule preparation, Dr. Tan said. During this session, surgeons also discussed the need for a tissue- engineered endothelial layer that can be used in place of human donor corneas. Developers are work- ing on a biocompatible carrier to de- liver the tissue-engineered endothelium. According to one speaker, Mesenchymal stem cells can alter their phenotype into endothe- lium-like cells, but more study is needed to identify the specific mi- croenvironmental conditions for this change. DALK to replace PK? In his talk, Marc Muraine, M.D., France, discussed whether DALK would eventually totally eclipse PK, the gold standard. DALK is more time-consuming Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from ESCRS 2012, Milan, Italy Donald Tan, F.R.C.S., Singapore, speaks during EUCornea Source: EyeWorld than PK, but it is convertible and vi- sual recovery is the same, Prof. Mu- raine said. "Endothelial density remains high after 10 years, and there is less