EyeWorld Asia-Pacific September 2012 Issue

September 2012 58 EWAP MEEting REPoRt Milan - from page 57 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 working on a biocompatible carrier to deliver the tissue-engineered endothelium. According to one speaker, mesenchymal stem cells can alter their phenotype into endothelium-like cells, but more study is needed to identify the specific microenvironmental conditions for this change. Ocular surface reconstruction and keratoprosthesis During a Cornea Society sponsored session titled “Ocular surface reconstruction and keratoprosthesis”, W. Barry Lee, MD , Atlanta, Ga., USA, discussed medical procedures and minor surgery for ocular surface disease, including topical and oral medications, punctal plugs, and “biological Band Aids” such as amniotic membrane grafts. Tarsorrhaphy, he said, “is the most underutilized procedure, at least in the states.” Previously, during the opening day of EUCornea on Thursday, incoming president José L. Güell, MD , said that visco-bubble dissection during deep anterior lamellar keratoplasty (DALKP) is less aggressive and offers a slower and more controlled dissection and better visualization. Still, “it needs to be demonstrated with properly designed studies,” Dr. Güell said. Another area being studied is femtosecond-assisted anterior lamellar keratoplasty, which offers an alternative to other anterior lamellar techniques and promises to be more repeatable, predictable, and simple, as well as “less dependent from surgical skill and suitable to become a ‘standard’.” Before symbolically handing over the “chains of office” to Prof. Guell, Harminder S. Dua, MD , Nottingham, UK, current president of EUCornea, gave the EUCornea Medal Lecture titled, “Redefining the surgical anatomy of the cornea.” Prof. Tan, current president of the Cornea Society and the Asia Cornea Society, spoke about continued cooperation between all of the societies as the third EUCornea commenced. Editors’ note: Dr. Tan has financial interests with Network Medical Products. None of the other speakers have financial interests related to their talks. Corneal vascularization In the first joint session with EUCornea, Dalia Said, MD , Cairo, gave an overview of different types of vessels in neovascularization. “Specific infections have specific patterns of vascularization,” she said. The vessels tend to follow planes—incisional planes along the healed scar lines of lacerations, graft-host junction or arcuate incisions and lamellar planes from deep lamellar keratoplasty and endothelial transplants. Dr. Said and colleagues studied 165 cases of neovascularization and found that nearly half of them were caused by infections. Broken, loose, and tight sutures also cause neovascularization along the suture track. Not all corneal vascularizations are the same. They have diverse causes and manifestations, said Dr. Said. Management of a CVA classification system is needed, she said. Practitioners have two goals— preventing corneal vascularization and preventing remnants of it, said Per Fagerholm, MD , Linkoping, Sweden. Complications of neovascularization include remnants of fibrovascular tissue, lipoid degeneration, and ghost vessels, which result in reduced visual acuity. “Ghost vessels remain and are very resistant,” Prof. Fagerholm said. Panelists continued with a discussion on the medical and surgical management of corneal neovascularization. Corneal vascularization is the No. 1 factor for graft rejection, and there is good empirical evidence that controlling vascularization helps promote graft survival, the experts agreed. Antiangiogenic treatment options differ depending on the type—either mature pericyte- covered vessels or immature outgrowing vessels, said Claus Cursiefen, MD , Cologne, Germany. Fine-needle cautery combined with subconjunctival and topical Avastin (bevacizumab, Genentech, San Francisco, Calif., USA) can be used on mature vessels prior to transplantation. Steroids, anti-VEGF, and antisense oligonucleotides against IRS-1 (GS-101 eye drops) strategies can be used as primary prevention during keratitis and tertiary prevention after transplantation. The eye drops are currently in Phase III trials and not available for commercial use yet, Prof. Cursiefen said, and there are still unsolved issues with the regimen, including dosing, duration, and timing of anti-lymphangiogenic therapies. “Avastin gives reliable regression in immature vessels,” Prof. Cursiefen said, pointing out that the use is off-label. “It does not seem to have an effect on resting nerves, but on regenerating ones.” Anti-VEGF on the ocular surface also may have effects on corneal epithelial and stromal healing, he added. Foremost, Prof. Cursiefen said, is treating the underlying disease