Eyeworld Daily News

46 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING Another paper took a look at surgical glaucoma manage- ment after ocular surface stem cell transplantation. Matthew Denny, MD, Cincinnati, Ohio, presented this research. He discussed the etiologies, chal- lenges, and treatments for stem cell deficiency/loss and the Further analysis revealed the Baerveldt 350 patients had lower subscores in self-percep- tion, reading function, general function, and socioemotional, Dr. Kilgore said. Baerveldt 350 patients having lower self-per- ception scores suggests they may be more aware or self-con- scious of the tubes, Dr. Kilgore said. Baerveldt 250, Baerveldt 350, or Ahmed FP7 (New World Medical) or were medically treated controls. The National Eye Institute 25-item visual function questionnaire, adult strabismus-20 questionnaire, and the diplopia questionnaire were given to patients at least 30 days postop (upon enroll- ment for controls). The study included 239 patients (Ahmed FP7 n=37, Baerveldt 250 n=35, Baer- veldt n=65, control n=102). Overall, the study found no difference in health-related quality of life scores among the three drainage devices. Univar- iate linear regression analysis found younger age, diplopia, a glaucoma drainage device, worse visual acuity, and worse mean deviation were associat- ed with lower health-related quality of life scores. When controlled for these factors, the researchers found patients with tubes had lower scores in most subscales of the surveys. by Liz Hillman Editorial Co-Director G laucoma surgical pro- cedures and outcomes were featured in a paper session. One paper looked at health-related quality of life in patients with a few different glaucoma drainage devices. Khin Kilgore, MD, JD, Roches- ter, Minnesota, presented the paper and noted that previous research found that patients with tubes had higher rates of diplopia than patients treated medically or with trabeculec- tomy. Dr. Kilgore said most of the patients with tubes in this research had Baerveldt 350 implants (Johnson & John- son Vision), leading she and her coresearchers to wonder if the type of drainage device had an impact on the patient's health-related quality of life. They conducted a pro- spective, case-controlled study from August 2017 through July 2019 where patients received a Research on glaucoma surgical procedures and outcomes All glaucoma failures in the tube group in Dr. Denny's study required surgical repair, and three tube revisions resulted in surface failures. All surface failures were in the location of the tube. Source: Matthew Denny, MD, screenshot from presentation However, if you exclude corneas with mild keratoconus and look only at those with a preoperative Kmax of 50 or greater, the flattening effect becomes even more significant. All eyes with a preop Kmax of 46 D or more experienced flattening after DMEK. Dr. Dockery added that significant reduction of corneal power was seen, reaching 4 D at 1 year. In one case, there was more than 20 D of flattening. The study also found a high graft detachment rate of 30%, which Dr. Dockery noted is about two or three times high- er than what is seen in DMEK in normal eyes. Of these, three required retransplantation and four were successfully treated with a rebubbling procedure. Why are there so many de- tachments in these patients? Dr. Dockery said by looking at a Scheimpflug image you can see a significant increase in the back elevation of the cornea, which could potentially lead to a curvature mismatch between the graft and the recipient. Samar Basak, MD, Kol- kata, India, shared a paper on endothelial cell density following DMEK using periph- erally trephinated donor tissue (DMEK-pD). The purpose of his study was to evaluate the clin- ical outcomes and endothelial cell density (ECD) following DMEK using DMEK-pD and compared to DMEK using cen- trally trephinated donor tissue (DMEK-cD) in patients with endothelial diseases of differ- ent etiologies. It was a retrospective com- parative interventional case series that included 500 eyes of 442 patients who underwent either DMEK-pD (n=235) or DMEK-cD (n=265) alone or combined with cataract surgery between January 2016 and De- cember 2018. All donor tissues were prepared by the operat- ing surgeon during surgery. Preoperative profiles, postoper- ative clinical outcomes, donor baseline ECD, and postoper- ative ECD were recorded at 6 months and 1 year. Subgroup analysis was done for Fuchs dystrophy and pseudophakic corneal edema. A p-value of less than 0.05 was considered statistically significant. The comorbidities were the same in both groups, Dr. Basak said, but glaucoma was more in the DMEK-cD group. Mean BCVA in both groups was similar at 6 months, but at 1 year, it was slightly less in the DMEK-cD group. ECD in the DMEK-pD group was statisti- cally much higher at 6 months and 1 year. View these presentations and more in SPS-302. Editors' note: Dr. Basak has finan- cial interests with Novartis and Santen. Dr. Dockery has no finan- cial interests related to his presen- tation. continued from page 42 continued on page 48

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