Eyeworld

E ndothelial keratoplasty (EK) is indi- cated for endothelial diseases such as Fuchs' corneal dystrophy, pseudophakic bullous keratopathy, and infection or iatrogenic-related corneal endothelial decompensation. The procedure continues to gain popularity exponentially. Eye Bank Asso- ciation of America data from 2016 for tissue utilization from U.S. eye banks indicated that EK has been the most commonly performed kerato- plasty procedure in the U.S. and also the fastest growing, with 6,027 EKs performed in 2006 domestically compared to 28,327 in 2016. While Descemet's stripping automated endothelial keratoplasty (DSAEK, where some residual stroma remains on the donor tissue) has remained relatively stable, Descemet's membrane endothelial keratoplasty (DMEK, where only DM and endothelial cells are transplanted) rates began to take off in 2016. In 2012, only 748 DMEK procedures were performed in the U.S. while in 2016, there were 6,459 DMEK procedures. Still, the higher rebubble rate, difficulty in stripping DM tissue (if one has no access to pre-stripped DMEK tissue), and high learning curve of the surgery has deterred many corneal surgeons from taking on DMEK surgery routinely. In this issue of EyeWorld, Massimo Busin, MD, Kevin Shah, MD, Neda Shamie, MD, and Sophie Deng, MD, discuss the differences among DSAEK, ultra-thin DSAEK, and DMEK, with regard to outcomes, complications, and patient communication and selection. Armand Borovik, MD, Reginald Robert Tan, MD, Mohit Parekh, PhD, Massimo Busin, MD, and Mauricio Perez, MD, share the strategies they use to prepare donor tissue for DMEK. For surgeons with no access to pre-stripped DMEK tissue and for those who service populations that cannot afford pre-stripped DMEK tissue, the idea of needing to perform this part of the procedure can be daunting. However, DMEK requires fewer resources than DSAEK to perform in the operating room, and if armed with pearls and a few chances to practice, the learning curve for DMEK tissue preparation can be overcome. Mark Terry, MD, provides some insight into pre-loaded patient-ready DMEK where donor tissue is completely prepared by the eye bank. An exciting area that we explore this month is alternative procedures to the EK procedures that surgeons are more familiar with. Amar Agarwal MD, Kathryn Colby, MD, and Jodhbir Mehta, MD, discuss pre-Descemet's endo- thelial keratoplasty (PDEK), primary Descemetorhexis, and cultivated corneal endothelial cells that can be injected. As the evidence for these procedures grows, they may assist in reducing the stress on the limited supply of donor corneas in many regions of the world outside of the U.S. Finally, Leejee Suh, MD, W. Barry Lee, MD, and Peter Veldman, MD, review their surgical pearls for beginning DMEK surgery. They discuss donor and recipient sizing, use of pre-marked DMEK tissue, case selection for those earlier on in the learning curve, and air bubble management. I hope you enjoy this issue of EyeWorld, and thank you to all the physi- cians for taking the time to share their expertise. EW World view All you need to know about cornea transplants The official publication of the American Society of Cataract & Refractive Surgery A S C R S January 2018 Vol. 23 • No. 1 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Monica Frishman monica@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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POSTMASTER: Send change of address to EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033. Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices. The ideas and opinions expressed in EyeWorld do not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G S T A F F Clara Chan, MD Cornea editor EyeWorld magazine is now online. Read it, Watch it, Share it The online version has videos and can be downloaded to your mobile device. You can email articles or the entire issue to a friend. digital.EyeWorld.org

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