EyeWorld India March 2013 Issue

46 EWAP CORNEA March 2013 However, he also said DMEK typically has a lower rejection rate. Dr. Ang said “safety in donor preparation and easier manipulation of the tissue in the anterior chamber” is a factor that continues to make the DSAEK technique more popular. “The challenge for thin DSAEK is for the eye banks to come up with techniques to provide reproducible and accurate thin tissue,” she said. Tissue loss and possibility of endothelial cell loss because of difficulties manipulating the delicate tissue were two possible risks with DMEK that Dr. Ang cited. “Solutions to these problems need to be found in order to make DMEK the procedure of choice for endothelial replacement,” she said. Technique preferences Dr. Busin said he is currently seeing a trend toward thin DSAEK, his preferred method. This allows for thinner grafts and thinner incisions with the DSAEK procedure. However, he said that some people may not trust this method yet, which could be why some are leaning toward DMEK. He said in the future he expects to see people favoring thin DSAEK. “The ease of surgery and the outcome, which is more or less the same, would convince them to move from DMEK back to thin DSAEK grafts,” Dr. Busin said. Likewise, Dr. Ang also said thin DSAEK is presently her procedure of choice. “This technique results in excellent visual outcomes, is technically less demanding than DMEK, and has fewer complications than DMEK at present,” she said. Dr. Price said he prefers the DMEK technique, although he still sometimes uses DSAEK. “If it’s a non-complicated case, we recommend DMEK,” he said. After nearly five years using DMEK, there are a number of reasons he favors it. He said better vision results are evident with DMEK. Another reason is rejection rates are significantly lower with DMEK. He said in a cumulative look at DMEK for a two-year period, the rejection rate was less than 1%, compared to about 12% for DSAEK. He said thin DSAEK does offer some similarities to DMEK. “I think the thinner it gets, the closer you’re going to get to DMEK,” he said. But the question, he said, is how close you can get and how reliable the thin DSAEK would be. Dr. Price said he stopped using thin DSAEK because of significant tissue loss in donor preparation. Currently DMEK donor loss rates are less than 1%; it will be interesting to see if donor loss rates will be that low if all donor preparations for DSAEK are for thin cuts, as there is always some irregularity and unpredictability with microkeratome cuts. Endothelial replacement future Endothelial keratoplasty has evolved over the years, Dr. Ang said. “The next phase will be cultured donor endothelial cell seeding of diseased corneas,” she said. “The ability to culture and expand donor endothelial cells will increase the donor supply, especially in countries with limited supply. These cells could be transplanted either as an injection-based therapy or on a carrier.” EWAP Editors’ note: Dr. Busin has financial interests with Moria. Drs. Ang and Price have no financial interests related to this article. Contact information Ang: angandrea@hotmail.com Busin : mbusin@yahoo.com Price : francisprice@pricevisiongroup.net Cornea - from page 44 LASIK Surgery 025,$ 6 $ UXH *HRUJHV %HVVH $QWRQ\ )5$1&( 3KRQH )D[ PRULD#PRULD LQW FRP ZZZ PRULD VXUJLFDO FRP • Thin, 100-micron, planar flaps • Accuracy and predictability equivalent to Femto-SBK • Smoother stromal bed • No femto-complications • … At a fraction of the cost Think Thin SBK without femto-furrow James Lewis, MD (Elkins Park, PA, USA) /HZLV -6 8QDQWLFLSDWHG VWURPDO WLVVXH ORVV IROORZLQJ IHPWRVHFRQG ÁDS FUHDWLRQ WK DQQXDO PHHWLQJ RI WKH (6&56 6HSW 3DULV )UDQFH /HZLV -6 6NHSWLFLVP DERXW /$6,. ÁDS GRJPD 2SKWKDOPRORJ\ 0DQDJHPHQW 'U /HZLV KDV QR ÀQDQFLDO LQWHUHVW DQG LV QRW D SDLG FRQVXOWDQW IRU 0RULD ,QWUD/DVH LV D SURGXFW DQG UHJLVWHUHG WUDGHPDUN RI $EERWW 0HGLFDO 2SWLFV ,QF ,UYLQH &$ 86$ © :H ZDQWHG WR VHH WKH JHRPHWU\ WKH DQDWRP\ RI WKH ÁDS HGJH >«@ , ZDV H[SHFWLQJ WKH )6 DQJOH WR EH ZHOO GHÀQHG DV WKHVH DUJXPHQWV KDYH EHHQ PDGH WKDW LW·V VR PXFK EHWWHU DQG VR PXFK PRUH VWDEOH ,Q DFWXDOLW\ , IRXQG GLVFRQWLQXLW\ D WRWDO DEVHQFH RI VWURPD DQG SRVVLEO\ VWURPDO WLVVXH ORVV $ ZHHN ODWHU \RX GRQ·W VHH WKH JDS LQ WKH 2&7 :KDW \RX VHH LV DQ HSLWKHOLDO SOXJ ÀOOLQJ WKH IXUURZ ZLWK D VOLJKWO\ GLIIHUHQW WLVVXH GHQVLW\ :H GR QRW VHH WKH ZHOO GHÀQHG HGJHV WKDW DUH WKHRUL]HG WR PDNH HQKDQFHPHQW VDIHU DQG HSLWKHOLDO LQJURZWK D WKLQJ RI WKH SDVW ,Q IDFW ZKDW ZH VHH PD\ EH WKH ÀUVW VLJQ WKDW WKH IHPWRVHFRQG ODVHU LV QRW D SDQDFHD >«@ 1RWKLQJ VXJJHVWLYH RI WLVVXH ORVV ZDV IRXQG LQ WKH 0RULD 6%. FDVHV ª 2&7 SLFWXUHV LPPHGLDWHO\ DIWHU 6%. ÁDS FUHDWLRQ /HIW ,QWUD/DVH N+] 5LJKW 0RULD 6%.