EyeWorld India March 2018 Issue

September 2017 3 EWAP EDITORIAL March 8 EYEWORLD ASIA-PACIFIC EDITORIAL BOARD A compendium on corneal transplants “ 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 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 I t gives me immense pleasure to present to you the new issue of the scientifically enriched EyeWorld Asia-Pacific . We begin this issue with the latest in corneal transplant surgeries. Descemet’s membrane endothelial keratoplasty (DMEK) is a challenging procedure. Various surgeons globally herein share their technique of tissue preparation. Practical surgical pearls for DMEK are also shared by senior specialists. For the tricky situation of Fuchs’ endothelial dystrophy coexisting with cataract, our issue guides you with a step by step approach including staging and procedures for special lenses. We have a section on various complexities of cataract surgeries. Here, the management of negative dysphotopsia with IOLs is described. IOL power calculation formulae have considerably advanced over the past few years, yet certain limitations to accuracy are inherent. Here we highlight screening techniques and the importance of surgeons personalizing their lens constant to get better results. Femtosecond laser-assisted cataract surgery—where do we stand today? To know the answer, read our review article comparing femto laser with manual phaco. We also have a section for young eye surgeons, on how and when to perform IOL exchange. In our refractive section, our authors describe the latest techniques to identify early keratoconus, ectasia, and dry eye status prior to corneal refractive surgery. The use of allogenic human donor tissue for refractive surgeries for presbyopia, PrEsbyopic Allogenic Refractive Lenticule (PEARL), and myopic SMILE are described as well. In our chapter on newer devices in ophthalmology, alternatives to femtosecond lasers such as Zepto and the ApertureCTC capsulotomy systems are introduced. In the glaucoma section, microinvasive glaucoma surgery (MIGS) using micro bypass stents (iStent) is discussed in depth. Our issue concludes with a pharmaceutical section, wherein we try going beyond prescription medications. For instance, the use of omega-3 fatty acids as natural therapy for Meibomian gland disease has been extensively studied recently. In addition, the use of compounded drops by glaucoma practitioners is described. Read on to know its benefits and legal implications. As always, I would like to conclude with a quote from Tirukkural The wise, who seek to understand deeper significance of things, will not utter words with no substantial worth. (Tirukkural, Chapter 20; Quote 198) EWAP S. Natarajan, MD Regional Managing Editor EyeWorld Asia-Paci c Graham Barrett Chief Medical Editorial EyeWorld Asia-Paci c