EyeWorld India September 2019 Issue

EWAP SEPTEMBER 2019 75 ºÜi…>Ûi ̜ ÕÃi œÕÀ «ÀœÜiÃà as surgeons to deal with these complicated situations,” said Dr. Sachdev. Crystal Clear Corneas and Anterior Segment Surgery Success in cataract and refractive surgery is often dependent upon the health of the cornea preop- eratively and how the cornea responds during the postop period. Add to that diseases that affect the cornea directly and ensuring its stability and health is of paramount importance, agreed a group of corneal ex- perts speaking on the topic. Descemet’s membrane endo- thelial keratoplasty (DMEK) may look similar to other EK proce- `ÕÀiÃ] LÕÌ ºˆÌ½Ã > ܅œi ˜iÜ «Àœ - cedure, and even my early, ‘easy’ cases were a struggle,” said Kavita Rao, MD . When perform- ing DMEK, she said punching a 3-mm hole into the stroma and then marking both sides of the ̈ÃÃÕi ºÀi>Þ…i«i` “i Ài“œÛi my fear of doing DMEK.” Takefumi Yamaguchi, MD , hypothesized that previous iris damage may be a cause of endothelial cell density (ECD) loss after keratoplasties, as a common clinical feature in eyes with ECD is iris damage. But }À>vÌ ÃÕÀۈÛ> `ˆvviÀà È}˜ˆwV>˜ÌÞ among damaged irises, leading to a subsequent hypothesis that pathological aqueous humor mediates ECD loss. Iris damage is also associated with chronic ˆ˜y>““>̈œ˜ ˆ˜ ̅i >µÕiœÕà humor, he said. º Þ Ì>Ži‡…œ“i “iÃÃ>}i is that corneal endothelial cell loss can be reduced due to pathological aqueous humor microenvironment caused by ˆÀˆÃ `>“>}i]»…i Ã>ˆ`° º ÕÀ̅iÀ] iris damage can deteriorate the aqueous humor condition.” He recommends avoiding or minimizing iris damage during cataract, glaucoma, and/or reti- nal surgeries. 1Ș} >˜ÌiÀˆœÀ Ãi}“i˜Ì optical coherence tomography (OCT) when available can help identify potential complications of deep anterior lamellar kera- toplasty (DALK), said Jodhbir Mehta, FRCOphth, PhD. º Ƃ V>˜ œvviÀ “>˜Þ È}˜ˆwV>˜Ì >`Û>˜Ì>}ià œÛiÀ penetrating keratoplasty, which is especially important in young patients,” he said. Endothelial cell counts can be affected by perforations that inadvertently œVVÕÀ `ÕÀˆ˜} ÃÕÀ}iÀÞ] ºLÕÌ }À>vÌ survival is good at over 90% at 10 years, regardless of whether or not the patient had a perfo- ration.” Tsutomu Inatomi, MD, PhD , noted that the primary pathogenesis and environmen- tal alterations in the anterior chamber appear to affect the endothelial cell reduction, but also said pathological modu- lation and novel cell injection therapy may have the potential ̜ ˆ“«ÀœÛi ̅i `ˆÃi>Ãi‡Ã«iVˆwV prognosis. SUMO: Wrestling with Challenges in Refractive Surgery Refractive surgery is an ever- changing and rapidly evolving technology, and a group of iÝ«iÀÌà 뜎i >LœÕÌ Ì…i º>ÌiÃÌ and greatest” in refractive sur- gery, from where to center laser treatments to wavefront-guided LASIK or SMILE, to cataract sur- gery planning in the post-laser vision correction patient, to pa- tient satisfaction in emmetropic presbyopes. In general, there is no real consensus on where treatment should be centered during refractive laser treatment, said John Chang, MD , with options