EyeWorld Asia-Pacific March 2018 Issue

September 2017 3 EWAP EDITORIAL March 8 E ndothelial keratoplasty as an alternative to penetrating keratoplasty has dramatically changed the management of pseudophakic bullous keratopathy and Fuchs’ dystrophy. The risk of rejection appears to be reduced, but the most dramatic differences are the rapid visual rehabilitation and safety when transplantation is limited to the replacement of the damaged endothelial layer. More recently, DMEK is challenging DSAEK as the preferred procedure due to the potential for faster visual recovery and improved visual acuity. The rate of endothelial rejection may also be somewhat reduced with DMEK compared to DSAEK, but despite the advantages DSAEK remains the most popular endothelial replacement technique performed today. The reason for the preference for DSAEK is the increased technical difficulty associated with DMEK, with higher re-bubbling rates. Moreover, the preparation of tissue which is described in detail in this issue is a delicate technique. Eye banks, however, are now beginning to provide tissue prepared for DMEK as well as DSAEK. This certainly removes one of the barriers to greater uptake of the procedure. An interesting variant of DSAEK which retains Dua’s layer is pre- Descemet’s automated endothelial keratoplasty (PDAEK). This provides support to the endothelium in addition to Descemet’s membrane which facilitates handling during surgery. Personally, I have found ultrathin DSAEK with tissue in the range of 50 to 70 µm provides excellent visual outcomes with rapid visual recovery not dissimilar to DMEK. Ultrathin DSAEK also retains the advantage of easier handling of tissue with low rates of repeat or secondary procedures. Even in expert hands there are some complex situations such as endothelial keratoplasty with sutured IOLs where DSAEK may be preferred. I suspect that the uptake of DMEK will continue to increase but that there will remain a place for both techniques, with DSAEK, particularly ultrathin DSAEK, remaining a popular alternative. The reports of Descemetorhexis alone and the continued interest in culturing endothelial cells for simple injection into the anterior chamber suggests that progress in the area of endothelial replacement will continue with ongoing refinements in the future. Endothelial keratoplasty is increasingly practiced by cataract surgeons as well as corneal subspecialists—a trend I believe will continue. The topic is relevant to all anterior segment surgeons and I hope you find the excellent articles on endothelial transplantation in this issue of interest. EWAP EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Hiroko BISSEN-MIYAJIMA, Japan Hungwon TCHAH, South Korea ASIA-PACIFIC CHINA EDITION Regional Managing Editor YAO Ke Deputy Regional Editors HE Shouzhi ZHAO Jialiang Assistant Editors SHENTU Xing-chao ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN Deputy Regional Editor Abhay VASAVADA ASIA-PACIFIC KOREA EDITION Regional Managing Editor Hungwon TCHAH Deputy Regional Editor Chul Young CHOI John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia A compendium on corneal transplants Graham Barrett Chief Medical Editorial EyeWorld Asia-Paci c “ I suspect that the uptake of DMEK will continue to in- crease but that there will remain a place for both tech- niques, with DSAEK, particularly ultrathin DSAEK, re- maining a popular alternative. ... progress in the area of endothelial replacement will continue with ongoing re- finements in the future. ” –Graham Barrett, MD