Eyeworld Daily News

8 | EYEWORLD DAILY NEWS | APRIL 6, 2024 ASCRS ANNUAL MEETING DAILY NEWS S essions on the ASCRS Cornea Day program covered complex cornea cases, keratoplasty, anterior segment and cor- nea surgical videos, and the ocular surface. Anterior lamellar keratoplasty techniques During a morning ASCRS Cornea Day session, Sadeer Hannush, MD, spoke about ALK and DALK tech- niques. He said that he is excited that the field is able to do layer-specific keratoplasty. When the patient comes in, we have to decide to offer a full thickness transplant or to transplant the layer affected by disease. Dr. Hannush shared some statis- tics from the Eye Bank Association of America (EBAA) from 2023. EK continues to be on the rise, while PK falls. But importantly, there are flat lines of ALK, he said, noting less than 598 ALKs last year. This is compared to more than 14,000 PKs and more than 33,000 EK. Dr. Hannush discussed the specif- ics of ALK and DALK procedures. His takeaway points were: • Think of superficial keratectomy for pathology anterior to Bow- man's. • Think of PTK, microkeratome- or femtosecond-assisted keratectomy for pathology in the anterior 200 microns of stroma. • Think of DALK for ectasia or pathology anterior to the pre-De- scemet layer. • Always consider DALK if you suspect the corneal endothelium is healthy. Editors' note: Dr. Hannush has no financial interests related to his presentation. Complicated IOL exchange with vitreous prolapse An afternoon Cornea Day session covered anterior segment and cornea videos, with presenters sharing on a variety of surgical procedures. Jessica Chen, MD, presented on complicated IOL exchange with vitreous prolapse. Early recognition of vitreous prolapse can help limit rupture and the amount of prolapse, she said. Signs may include sudden AC deepening with pupillary dila- tion, iris peaking, and fluid currents stop from vitreous clogging. Vitreous prolapse may also cause dislocated lenses, loose zonules, and capsu- lar phimosis. Vitreous dangers can include limited elasticity, pulling can lead to retinal tears/detachment and macular edema, and you could have corneal decompensation or vitreous wick. Dr. Chen suggested several tips for managing vitreous prolapse as an anterior segment surgeon: • Triamcinolone/vitrectomy prior to lens removal • Consider main wound suture • Incision through the cornea or PPV with a 23-gauge MVR blade or trocar • Infusion into the anterior chamber • High cut rate • Target sub-incisional and around the iris • Miosis Editors' note: Dr. Chen has no financial interests related to her presentation. I wish I had done a DSAEK instead Kavitha Sivaraman, MD, shared a case where she had a difficult time with DMEK. One issue with those learning DMEK, she said, is they tend to be too tentative when placing the injector tip into incisions. In the case Dr. Sivaraman showed, there was first an issue with the air bubble that she didn't notice because she was worried about the iris, but the bubble exited the eye, and the graft stayed in place. The best time to center the graft is when you have one edge free but before the graft is fully unscrolled. Dr. Sivaraman described a technique that she likes to use if she has to move the graft. She puts in a small air bubble to create friction and move the graft laterally with a sweeping movement on the cornea. The bubble needs to be small, and the pressure in the eye needs to be relatively low. In her case, Dr. Sivaraman later discovered that the S-stamp appeared to be inverted. She used a direct stream of balanced salt solution toward the iris to flip it. The graft looked fine, but the S-stamp was not ideal, and it looked dark and smudged. She discovered a central "ghost" S-stamp, with some apposi- tional staining of the S-stamp once the scroll was introduced. ASCRS Cornea Day covers plethora of topics in the subspecialty continued on page 10 Dr. Chen presents on complicated IOL exchange with vitreous prolapse. Source: ASCRS

• Cover