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48 | EYEWORLD DAILY NEWS | MAY 6, 2019 ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Lauren Lipuma EyeWorld Contributing Writer Surgeons now have promising options specifically for Fuchs' dys- trophy: Descemetorhexis without endothelial keratoplasty (DWEK) or Descemet's stripping only (DSO). In these procedures, the central 4 to 4.5 mm of Descem- et's membrane is stripped but not scored, allowing for migration of endothelial cells and clearing over 1 to 6 months. However, the rate of recovery is variable with these procedures and surgical technique is important in visual recovery, according to Dr. Farid. As surgical techniques and eye banking procedures evolve, outcomes and safety with all of these procedures will continue to improve, she concluded. Editors' note: Dr. Gupta has financial interests with Johnson & Johnson Vi- sion. Dr. Farid has no financial interests related to her comments. purest form of endothelial kera- toplasty, according to Dr. Farid. In DMEK, surgeons replace only Descemet's membrane and the corneal endothelium, but because the tissue is so thin (15 microns), unrolling and inserting the tissue is challenging. There are also increased challenges for eyes with glaucoma or poor iris anatomy. As a result, surgeons have been slow to adopt DMEK, but eye banks now preloading the tissue make it a much more repro- ducible procedure, Dr. Farid said. Although DMEK is best in terms of anatomy, there is still a role for DSAEK in complex eyes, she said. DSAEK procedures replace Descemet's membrane and the corneal endothelium as well as some stroma, and grafts are typ- ically around 120 microns thick. But newer, ultrathin DSAEK has thinner grafts of around 80 microns, which do provide better and faster visual recovery, Dr. Farid said. provides control on the level of heating and expression of the glands. Dr. Gupta prefers these op- tions over medical management of MGD because compliance is often an issue. "We're all busy, and a lot of these patients are young patients with MGD, and I think that while we can write down whatever we want on a piece of paper, when it comes to implementing it, it's very difficult," she said. Marjan Farid, MD, Irvine, California, provided some clarity on the "alphabet soup" of options for treating corneal endothelial disease. Advances in endothelial keratoplasty have provided thinner grafts that speed visual recovery and increase the quality of postop vision, but the surgical challeng- es have increased along with the treatment options, making it diffi- cult to pick the correct procedure for each patient, Dr. Farid said. DMEK provides the best and fastest visual recovery, as it is the I t can be hard to pick the right treatment for dry eye disease or endothelial kerato- plasty with so many available options, but speakers at yesterday's "Cornea Essen- tials" symposium provided attendees with some clarity on the differences between various treat- ments and procedures for these commonly seen conditions. Preeya Gupta, MD, Durham, North Carolina, discussed the vari- ous in-office treatments available for treating meibomian gland dysfunction (MGD) and dry eye disease. Chronic untreated meibo- mian gland dysfunction can lead to atrophy of the glands, so early intervention is beneficial not only to relieve the patient's symptoms but also to limit the potential for gland atrophy, Dr. Gupta said. It's important to incorporate both a heating treatment and debridement when treating MGD, Dr. Gupta said. She recommends starting with one of the heating treatments and seeing how the patient responds before moving on to the next. Heating treatment options include the LipiFlow (Johnson & Johnson Vision), intense pulsed light therapy, and the iLux device (Tear Film Innovations). Lipi- Flow has the longest track record, having been approved by the FDA in 2011, and provides precise heat to the posterior eyelids where the meibomian glands are located. Intense pulsed light therapy, which has traditionally been used in dermatology, involves using a non-laser light source to apply heat to the eyelids. The iLux is a handheld device with a magnifier to inspect, heat, and express the meibomian glands. The device is unique in that it allows direct visualization of the glands and Surgeons provide clarity on a myriad of options for corneal and ocular surface disease EXPERIENCE EYEWORLD 24/7 EyeWorld.org • Recent articles in web-friendly format • Searchable archives from 2007 to present • EyeWorld Weekly news feed • Trending videos • Live Twitter feed • CME and non-CME supplements • Links to all EyeWorld video sites

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