Eyeworld

News July 2018 Vol. 15, No. 3 A Cornea Society publication T he 2018 Cornea Day at the 2018 ASCRS•ASOA Annual Meeting in Washington, D.C. kicked off with a session on "Surgical Scenarios: Managing DMEK Disasters and Other Cornea Catastrophes." Neda Shamie, MD, Los Angeles, presented "DMEK: Care to Dance?" DMEK is difficult, but when you get past the learning curve, it's an elegant and beautiful surgery, she said. One of the challenges with DMEK can be the graft configuration. Dr. Shamie described the different types of configurations as old paper map scroll, colonial hat, burrito fold, taquito roll, carpet roll, and upside down. The old paper map scroll is a double scroll, but you don't always encounter this. The key, she said, is not to open it until it's centered because it's easier to center when it's still scrolled on the edges. The burrito fold also acts like the double scroll. By tapping and nudging it over with a slightly shallow chamber, you can open it easily. Meanwhile, the carpet roll is a little more difficult to open, according to Dr. Shamie. You want a shallow chamber, and you want the pupil restricted. Dr. Shamie recommended pressing down to try to shallow the chamber where the open edge of the "carpet" is. Dr. Shamie said that the taquito is the "dreaded configuration," and recom- mended putting in an air bubble to help open it. For upside down configurations, she said to angle the fluid down so that it sweeps over and flips the graft around. If it's upside down, the S-stamp will display the wrong way. The second session of Cornea Day was titled "Smoke or Fire?" and high- lighted inflammatory and infectious eye disease. Victor Perez, MD, Durham, North Carolina, shared tips for evaluating patients with corneal ulceration. First, he stressed the importance of stepping away from the slit lamp during the clin- ical exam. Getting a clinical history and talking to the patient is important. Dr. Perez also said to review medications, do an external examination, and do a full ophthalmic exam. Use your pattern recognition skills as well. His second step for evaluation of patients with corneal ulceration was to know the common diseases "where you live." It's also important to know the common diseases in your population of patients. Sonal Tuli, MD, Gainesville, Florida, presented "When Fluoroquinolones Fail: Diagnostic Approach to Atypical Corneal Infections." Atypical corneal infections could be categorized as those where the appearance is not typical, where there is no response to typical antimicrobials, or where the resolution is not typical (with relapses or recurrence). What should you do if the infection is atypical? Looking at the eye and doing a clinical exam may be helpful. If there are patterns, you could save time, mon- ey, and eye, she said. Dr. Tuli also mentioned the use of culture or smears, which could allow for identification, as well as sensitivi- ties. The culture would ideally be taken before treatment, but could be valuable even if the patient is on antibiotics. She said that using an in vivo confo- cal microscope could be helpful in these cases, noting that skills are required to perform and interpret it. Corneal biopsy may be a useful option. Dr. Tuli suggested using a 3-mm dermal punch. She said to do partial thickness trephination and dissect. A variety of topics highlighted at the 2018 Cornea Day continued on page 3 Attendees at the 2018 Cornea Day

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