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EW SHOW DAILY 40 ASCRS Symposia Monday, May 8, 2017 of corneal ectasia. Rajesh Fogla, MD, Hyderabad, India, described, corneal ectasia in an atopic young patient with prior hydrops. His case involved a 14-year-old male with a history of vernal conjunctivitis for the past 5 years. The patient had a history of eye rubbing and presented with a sudden decrease in vision in the right eye for the past week. Dr. Fogla noticed diffuse corneal edema involving the inferior half of the ectatic cornea and acute hydrops. To treat the patient, he used an inferior peripheral iridectomy and C3F8 (13%) gas injected into the AC. There was good resolution of the edema 1 month later, he said. In conclusion, Dr. Fogla said that hydrops can be managed using non-expansile gas injection into the anterior chamber. If the scar does not involve the visual axis, consider deep anterior lamellar keratoplasty (DALK) surgery, he said. Preoperative evaluation and surgical planning are essential, Dr. Fogla added, and intra- operative microperforation can be managed effectively. Postoperatively, Dr. Fogla said to manage the ocular surface judiciously. The final section of the sym- posium looked at management of corneal opacification and graft failure, and presentations focused on corneal scarring in a younger patient with reduced endothelial cell density, visually significant recurrent corneal stromal dystrophy following PTK, Descemet's stripping automat- ed endothelial keratoplasty (DSAEK) failure, and PK failure. Dr. Macsai presented on DSAEK failure, sharing the top five causes of DSAEK donor failure: donor recovery and preserva- tion, factors at surgery, mechanical issues, immunological issues, and cellular attrition. EW Editors' note: Dr. Price has financial interests with Haag-Streit (Koniz, Switzerland). Dr. Talley Rostov has fi- nancial interests with Allergan (Dublin, Ireland), Bausch + Lomb (Bridgewa- ter, New Jersey), Ocular Therapeutix (Bedford, Massachusetts), and Shire (Lexington, Massachusetts). Drs. Fogla and Macsai have no financial interests related to their comments. by Ellen Stodola EyeWorld Senior Staff Writer 68-year-old woman with a history of Fuchs' dystrophy and cataract. She said you want to consider a number of factors, including what the BCVA is, if there is morning blur, how the patient's activities in daily life are affected, the grade of the cataract and the grade of the guttata, the pachymetry, the endothelial cell density (ECD), and other patient considerations. Dr. Talley Rostov's patient had BCVA of 20/50, glare with headlights when driving at night but no morn- ing blur, ECD of 870, and pachyme- try of 589. When considering treatment options, Dr. Talley Rostov said you need to decide when to do a com- bined procedure. With epithelial edema, she said a combined proce- dure would be indicated. It would also be indicated for stromal edema with morning blur, pachymetry generally greater than 620 microns (which depends on the baseline) and ECD of less than 800. Dr. Talley Rostov discussed when it may be appropriate to do cataract surgery before DSEK/DMEK. The second section of the symposium looked at management and what the risks and complica- tions are. He said to typically choose the least invasive option, which for him is Descemet's membrane endothelial keratoplasty (DMEK), which is only Descemet's and endothelial cells. It offers the best visual recovery and least risk of rejection, Dr. Price said. "But we still have unpredictable refractive changes." DMEK is becoming more like cataract surgery, Dr. Price said. Some patients are 20/20 or 20/40 by day 5, he said, noting DMEK accelerates cataract formation a little more than with Descemet's stripping endotheli- al keratoplasty (DSEK) or penetrating keratoplasty (PK). Dr. Price also described decision- making for cataract with corneal problems. Make sure the AC depth is deep enough for later phaco, he said, and if not, remove the lens during DMEK. "In summary, it's all about deci- sions," he said, adding to remember that the number one thing is patient symptoms. Audrey Talley Rostov, MD, Se- attle, spoke about Fuchs' dystrophy and cataract, presenting a case of a O n Sunday morning, a sym- posium sponsored by the Cornea Society focused on decision-making in corneal transplantation, with case-based presentations. The session was moderated by Anthony Aldave, MD, Los Angeles, and Mari- an Macsai, MD, Glenview, Illinois. The first section of the sympo- sium focused on management of corneal edema. To kick off the session, Francis Price, MD, Indianapolis, discussed managing corneal edema with mod- erate Fuchs' dystrophy in a 50-year- old, giving an overview of how to handle Fuchs' dystrophy. When making decisions, you have to consider patient symptoms, potential surgery, and objective find- ings on the exam, Dr. Price said. The treatment choices have evolved over the years, he said, as to when to graft with Fuchs' dystrophy. What you do depends on your options, Dr. Price said. Options will depend on the experience of the surgeon and the individual situation of the patient. For each option, Dr. Price said it's important to look at how reliable the visual recovery is Case-based presentations on decision- making in corneal transplantation Dr. Talley Rostov presents a case she handled of Fuchs' dystrophy and cataract.

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