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10 | EYEWORLD DAILY NEWS | APRIL 6, 2024 ASCRS ANNUAL MEETING DAILY NEWS For pediatric penetrating ker- atoplasty, there are some specific preoperative considerations. General anesthesia needs to be used. Pedi- atric eyes also have high posterior pressure. Dr. Fung also recommend- ed a Flieringa ring in anyone under the age of 12. For trephination, eyes with congenital opacities are smaller. It's important to make sure you have that inventory before going into the operating room, he said. The true challenge in these cases starts after surgery, Dr. Fung said. Typically, immunosuppression is achieved by topical steroids. This will be slowly tapered over the course of 1 year. Suture management is also important. Depending on the age of the patient, this could be as early as 4 weeks after surgery in cases of infantile keratoplasty. Dr. Fung rec- ommended close follow-up for timely management of complications, such as glaucoma, cataract, suture-related issues, etc. Family commitment really is the key to success, Dr. Fung said. Editors' note: Dr. Fung has financial interests with Daiichi Sankyo, Dompe, and Santen. Medical management of limbal stem cell deficiency In the final session of ASCRS Cornea Day, which focused on the ocular sur- face, Clara Chan, MD, presented on the medical management of limbal stem cell deficiency (LSCD). Early diagnosis of LSCD can improve prognosis, she said. Medi- cal therapies to optimize the ocular surface environment can reverse mild LSCD, and it's important to eliminate causative factors and treat comor- bid conditions. Treatment options depend on disease severity/laterality and epithelium stability. A scleral contact lens may obviate or delay the She didn't think much of this is- sue with the S-stamp in her case, but then several surgeons experienced similar issues with dark S-stamps and appositional staining of preloaded scrolls. There were also slow-to-clear grafts and a few instances of primary graft failure. Eye bank investigation traced the issue to a specific corne- al marker, and use has since been discontinued. Dr. Sivaraman also offered clinical pearls for DMEK surgery: communicate, pick your battles, and beware of bubbles. She said it's important to com- municate with your eye bank if you have any tissue quality concerns. They can't track or address issues unless surgeons report to them. She also said perfect centration can be the enemy of good; you have to know when to quit. Have respect for the bubble. The bubble is going to gravitate toward the highest point, so if it's not where you want it, tilt the eye, she said. Editors' note: Dr. Sivaraman has fi- nancial interests with Bausch + Lomb, Glaukos, Katena, Lumata Health, and Novaliq. Pediatric keratoplasty Simon Fung, MD, shared a pediatric keratoplasty presentation, a case he wished he had done during fellow- ship. The case was in 2019 of an 8-week-old girl whose right eye had congenital anterior staphyloma. The left eye had a large central opacity. He shared instances of other types of pediatric corneal opacities, which can include Peters anomaly, corneal scar, depositional opacity, anterior segment dysgenesis, corneal dermoid, or endothelial dystrophy. To differentiate, diagnostic imag- ing is very important, Dr. Fung said. UBM is probably the most useful tool among the many machines, and clini- cal genetics is also becoming useful. need for surgical intervention, Dr. Chan said. When you look at staging, Dr. Chan said that if the central 5 mm is involved, it automatically becomes Stage II or III. She spoke about a landmark paper on how medical treatment can reverse LSCD, pub- lished in Ophthalmology in 2014, which discussed how you can rebuild the stressed niche area. Dr. Chan also discussed medical treatment principles for LSCD. First, eliminate toxicities, inciting factors, and physical trauma to LSCD niche. Reduce inflammation and provide nutritional support to the limbal stem cells. Dr. Chan shared a chart of options in the ocular surface opti- mization toolbox. These included categories of lubricants, anti-inflam- matories, nutritional support, lid margin disease management, and adjuncts. She suggested to "throw in one thing from each category to be aggressive." Editors' note: Dr. Chan has financial interests with a variety of ophthalmic companies. continued from page 8 Dr. Fung shares a presentation on pediatric keratoplasty. Source: ASCRS

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