EyeWorld Asia-Pacific December 2016 Issue

December 2016 54 EWAP cornea With the new technique, diseased cells in the central cornea such as these are replaced by healthier ones with no guttae. Source (all): Kathryn Colby, MD, PhD For an eye with Fuchs’ dystrophy, the new Descemet’s stripping without endothelial replacement procedure may help avoid the need for transplantation of foreign cells. by Maxine Lipner EyeWorld Senior Contributing Writer Finessing Fuchs’ A novel procedure may reduce the need for transplants F For patients with Fuchs’ endothelial dystrophy, a new procedure may help clear the cornea without the need for transplantation of foreign cells. Results published in Cornea indicate that in about 75% of cases the technique, known as Descemet’s stripping without endothelial replacement, was successful. This novel technique is a departure from the current standard of care of corneal transplant, which requires use of foreign cells, according to Kathryn Colby, MD, PhD , Louis Block Professor and chairman, Department of Ophthalmology and Visual Science, University of Chicago. With the transplantation of foreign cells comes the need for continued topical steroid use with potential side effects such as cataract formation, a rise in IOP, and a predisposition to infection, Dr. Colby noted. “Corneal tissue is also quite expensive and availability is limited in some areas of the world,” she said. With the new technique, 4 mm of both the central endothelium and the Descemet’s membrane are removed. “It’s similar to the first step of the normal endothelial keratoplasty in which the anterior cornea is marked to indicate the amount of endothelium and Descemet’s to be removed. Then I use a reverse Sinskey hook to score the tissue and physically remove it from the eye,” Dr. Colby explained. “That’s identical to the initial stages of DSEK and DMEK,” she said, adding that the idea is to allow the patient’s own remaining peripheral endothelial cells to cover the newly created defect rather than transplanting foreign tissue. Studying the technique In the retrospective case series, investigators considered how 11 Fuchs’ dystrophy patients on whom Dr. Colby performed the Descemet’s stripping procedure fared. The procedure was performed on 13 eyes, with patients who ranged in age from 51 to 91. All underwent the procedure in conjunction with phacoemulsification. After first inserting an IOL, a 4-mm area of the central Descemet’s membrane was stripped. Investigators found that in most cases, patients will respond to the procedure. “The peripheral endothelial cells repopulated the central cornea in about 75% of people in our series,” Dr. Colby said, adding that these are healthier cells that have no guttae. “In patients in whom the technique works, the cornea clears and thins. These are their own endothelial cells so they don’t need any chronic topical steroids,” she explained. The procedure adds very little time to the cataract removal. “I did these procedures after cataract surgery while the eye had viscoelastic in it from the intraocular lens implantation,” Dr. Colby said. “I marked the anterior cornea, put a Sinskey hook in through the cataract wound, and stripped the central Descemet’s.” After removal of tissue, the cornea remains swollen for a period of time before clearing. The time needed for this varied between 3 weeks and 6 months. “Most patients who responded to the procedure were clear by 3 months,” Dr. Colby said. Dr. Colby theorizes that the reason that the patient’s cells continued on page 56