Eyeworld Daily News

24 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he final session of the Cornea Day program looked at "where we were and where we're going." Mark Mannis, MD, presented on the history of keratoplasty, and a discussion with moderators Edward Holland, MD, and Francis Mah, MD, and panelists Michael Belin, MD, Marguerite McDonald, MD, Peter Laibson, MD, Roberto Pineda, MD, and Marian Macsai, MD, examined the past, present, and future of cornea. The contemporary repertoire of keratoplasty is varied, Dr. Man- nis said. Success in keratoplasty, he said, relies on surgical instru- mentation, tissue biology and biocompatibility, optical function of the graft, surface biointegra- tion, and eye banking. Surgical transitions occur when physicians discover the instruments they're using don't fit the bill, when there are new bio- logical insights, or when they find a better way to do things. Dr. Mannis continued by discussing the different stages of development of keratoplas- ty, including its inspiration and conception in the 18th century; experimentation and development in the 19th century; success and refinement in the 20th century; and selective layer and cell-based therapy in the 21st century. Penetrating keratoplasty be- came the standard of care for 100 years, Dr. Mannis said. There were some deviations, including femto- second laser-assisted keratoplasty, he said, adding that the visual results are nice, but it's expensive to perform. Lamellar keratoplasty became popular, including DALK, DSAEK, and DMEK. Dr. Mannis noted that this was not a new procedure, but the innovation that occurred was the ability to bare Descemet's membrane. Dr. Mannis mentioned the Boston KPro, the bio-engineered cornea, and more recent research into cell-based therapy and endo- thelial replacement. Surgical procedures evolve with increased understanding of corneal physiology, improved technology and instrumentation, monitoring of outcomes, and careful prospective evaluation, Dr. Mannis concluded. During the panel discussion, Dr. Laibson discussed the history of corneal fellowship education, noting that when he finished his residency at Wills Eye Hospital in 1964, there were only two places to do a year-long corneal fellow- ship. He noted the contributions in this area of Claes Dohlman, MD, PhD, who he trained with. Commenting on the develop- ment of corneal refractive surgery, Dr. McDonald shared her experi- ence in the field, discussing how she worked with a team doing "controversial research" and ulti- mately performed the first human laser vision correction procedure in 1988, which led to FDA clear- ance to do a human clinical trial. Looking to more recently developed techniques, Dr. Mac- sai discussed the DSO/DWEK technique and noted that she thinks it's going to revolutionize the whole way to approach the endothelium. There is so much research being done on it now, she said, adding that it's not yet clear if it will be cell engineering or pharmacologic activation of cell regeneration or using growth factors, or some combination of these options. She thinks this is an extraor- dinary development for patients. It could potentially be as simple as an injection, she said, and DSO could be done by comprehensive ophthalmologists. Shifting the discussion to eye banking, Dr. Holland brought up the concept of being able to ship cells to help those who are blind around the world. But if this happens, what happens to eye banking? Eye banking has never been stagnant, Dr. Mannis said. Eye banks have changed technical expertise and how they manage tissue, and he thinks that with the focus on cell-based therapy, it's clear the system of eye banking doesn't work in the developing world. We're going to have to find new ways to transmit tissue from laboratories to the rest of the world, he said. Editors' note: The speakers have no relevant financial interests. The past, present, and future of cornea highlighted in Cornea Day session Dr. Mannis serves on a panel at Cornea Day. Source: ASCRS

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