EyeWorld Asia-Pacific September 2019 Issue

62 EWAP SEPTEMBER 2019 CORNEA LÌ y>>Ì`ÕVi` VÕVÌÛ> wLÀÃÃ >Ã VVÕÀÃ mucus membrane pemphigoid and Stevens- Johnson ÃÞ`Ài]» À° *yÕ}vi`iÀ Ã>`° All this highlights the fascinating complexity of the ocular surface, and also ocular surface disease and >>}iiÌ° ºƂÃ Üi Ì> >LÕÌ it, you can see that dry eye is a complicated disease,” Dr. Û>iÃ> Ã>`° º ÌÃ Ã«iÃÌ form, when treating dry eye, wÀÃÌ ÞÕ ii` Ì µÕiÌ `Ü y>>Ì°» 7i VV>Ã ÃÕ` then go on to identify and treat the underlying causes of any given patient’s condition, >Ìy>>ÌÀÞ ÌiÀ>«iÕÌVÃ remain an essential component of ocular surface management. EWAP Editors’ note: Dr. de Luise is assistant ENKPKECN RTQHGUUQT QH QRJVJCNOQNQI[ ;CNG 7PKXGTUKV[ 5EJQQN QH /GFKEKPG 0GY *CXGP %QPPGEVKEWV CPF JCU PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU &T *QNNCPF KU FKTGEVQT QH %QTPGC 5GTXKEGU %KPEKPPCVK '[G +PUVKVWVG %KPEKPPCVK CPF JCU ƂPCPEKCN KPVGTGUVU KP -CNC 2JCTOCEGWVKECNU 0QXCTVKU 6CMGFC CPF 5GPLW &T Hovanesian practices at Harvard Eye #UUQEKCVGU .CIWPC *KNNU %CNKHQTPKC CPF JCU ƂPCPEKCN KPVGTGUVU KP #NEQP #NNGTICP $NGRJ'Z ,QJPUQP ,QJPUQP 8KUKQP 5WP 2JCTOCEGWVKECN 0QXCNKS 5JKTG CPF '[GXCPEG &T 2ƃWIHGNFGT KU VJG ,COGU CPF /CTICTGV 'NMKPU %JCKT KP 1RJVJCNOQNQI[ $C[NQT %QNNGIG QH /GFKEKPG *QWUVQP CPF JCU ƂPCPEKCN KPVGTGUVU KP 5JKTG #NNGTICP CPF 5GPLW investigators weren’t expecting because technically Ì½Ã Ài V>i}}° º ÕÌ Ìi studies have reported better visual outcomes with DMEK compared to DSAEK, with lower À>ÌiÃ v }À>vÌ ÀiiVÌ]» À° Õ«Ì> Ã>`° º7i ii` Ì Ü>ÌV to see whether longitudinally this has any impact on the long- term graft failure.” Investigators also found that the leading indication for full thickness procedures continues to be a failed graft, Dr. Gupta reported. Still, partial thickness procedures, which had accounted for about two-thirds of those in the initial study, in a short period of time were up to 85%. She said this could be attributed to improved visual outcomes, reduced astigmatism, and possibly fewer suture complications compared to penetrating keratoplasty. Dr. Gupta also credits surgeons’ growing experience with DMEK, which was new to many in 2013, with practitioners at the time facing a learning curve with the rapid growth of the procedure. DSAEK’s popularity held in bullous keratopathy cases. º/Ã>Ã Lii ÃÜ Ì>Ûi less endothelial cell loss post- transplant,” Dr. Gupta said, adding that while such bullous keratopathy cases are still mainly treated by DSAEK, DMEK is gaining ground. Results showed that the most common cause for corneal transplant was Fuchs’ dystrophy, which accounted for 42% of the transplants performed, with graft failure at 17%, and bullous keratopathy and keratoconus both at 15%. In Dr. Gupta’s view, corneal transplantation has changed a Ì° º «>Ài` Ì > `iV>`i ago, there has been a huge ÃvÌ]» Ãi Ã>`° º ÕÃÌ Ìi >ÃÌ 5 years, partial thickness has dominated compared to PKP, and although DSAEK was the procedure of choice for our most common pathologies, it’s now DMEK at the University of Toronto.” 7i >Þ ÃÕÀ}iÃ >Ài>`Þ favor this, there is opportunity for further growth, she pointed out. Use of precut donor tissue >Þ Li i ÃÕV>ÛiÕi° º v ÞÕ remove the time that it takes for DMEK, in terms of OR time when you’re preparing corneal tissue and it’s ready to go, that’s a huge improvement and will help to increase adoption.” Going forward, Dr. Gupta thinks more studies are needed to help determine whether new complications or changing impact on graft survival are going to emerge as a result v `} Ài ° º Ì another study similar to this in a few years will help give us some of the longitudinal data to understand whether the observed patterns have changed the outcomes,” she said. EWAP 'FKVQTUo PQVG &T )WRVC KU 2TQHGUUQT CPF &QTQVJ[ 2KVVU %JCKT &GRCTVOGPVU QH 1RJVJCNOQNQI[ 8KUKQP 5EKGPEGU CPF .CDQTCVQT[ /GFKEKPG CPF 2CVJQDKQNQI[ CPF RTQHGUUQT &CNNC .CPC 5EJQQN QH 2WDNKE *GCNVJ 7PKXGTUKV[ QH 6QTQPVQ 5JG JCU ƂPCPEKCN KPVGTGUVU KP #NNGTICP References £°> -7-] iÌ >° iÜ ÌÀi`Ã corneal transplants at the University of Toronto. Can J Ophthalmol . Óä£nÆxÎ\xnäqxnÇ° 2. Le R, et al. Current indications and surgical approaches to corneal transplants at the University of Toronto: A clinical-pathological study. Can J Ophthalmol. Óä£ÇÆ xÓ\Ç{qÇ° 7>Ì½Ã iÜ vÀ «>}i x