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EW SHOW DAILY 12 ASCRS News Saturday, April 14, 2018 by Ellen Stodola EyeWorld Senior Staff Writer a shallow chamber, and you want the pupil restricted. Dr. Shamie recommended pressing down to try to shallow the chamber where the open edge of the "carpet" is. Dr. Shamie said that the "taqui- to" is the "dreaded configuration," and recommended putting in an air bubble to help open it. For upside down configurations, she said to angle the fluid down so that it sweeps over and flips the graft around. If it's upside down, the S-stamp will display the wrong way. Dr. Shamie asked other panelists what they would do with a deeper chamber when the graft doesn't C ornea Day kicked off on Friday morning with a session on "Surgical Sce- narios: Managing DMEK Disasters and Other Cor- nea Catastrophes." The session was moderated by Audrey Talley Ros- tov, MD, Seattle, and John Berdahl, MD, Sioux Falls, South Dakota. Neda Shamie, MD, Los Angeles, presented "DMEK: Care to Dance?" DMEK is difficult, but when you get past the learning curve, it's an ele- gant and beautiful surgery, she said. One of the challenges with DMEK can be the graft configu- ration. Dr. Shamie described the different types of configurations as: old paper map scroll, colonial hat, burrito fold, taquito roll, carpet roll, and upside down. The "old paper map scroll" is a double scroll/roll, but you don't always encounter this. The key, she said, is not to open it until it's centered because it's easier to center when it's still scrolled on the edges. The "burrito fold" also acts like the double scroll. By tapping and nudging it over with a slightly shal- low chamber, you can open it easily. Meanwhile, the "carpet roll" is a little more difficult to open, according to Dr. Shamie. You want behave, and she also asked if it's important to consider myopia and axial length. Sumitra Khandelwal, MD, Houston, said that it may be a good choice to avoid myopic and deeper chambers for a surgeon's early cases. She recommended pulling out some of the fluid in deeper chambers. "It's tough for us as anterior segment surgeons to see a shallow chamber," she added. During his presentation, Bran- don Baartman, MD, Sioux Falls, South Dakota, presented a case of a Cornea Day highlights DMEK, cornea catastrophes, and inflammatory and infectious eye diseases by Ellen Stodola EyeWorld Senior Staff Writer A n afternoon session at Cornea Day focused on "Advances and What's Trending in Ocular Sur- face," with moderators Marjan Farid, MD, Irvine, Califor- nia, and Shahzad Mian, MD, Ann Arbor, Michigan. Within this session, topics covered included understanding dry eye disease, new treatments in dry eye disease, and surgical advances in ocular surface disease. Penny Asbell, MD, New York, discussed "Omega-3 Fatty Acid Sup- plementation for Treatment of Dry Eye Disease: Dry Eye Assessment and Management Study (DREAM)." The DREAM study was a NEI/NIH funded trial. It had no pharmaceutical bias, was a randomized controlled trial, double-masked, and was 1 year long, with well-defined subjects and end- points for signs and symptoms of dry eye and inflammation, Dr. Asbell said. It sought to look at the effec- tiveness and safety of omega-3 fatty acids for moderate to severe dry eye disease. The goal, Dr. Asbell said, was to include a broad spectrum of symp- tomatic patients with moderate or severe dry eye disease. The patients in the study were real world pa- tients, who could continue their current treatment, had symptoms for at least 6 months, and had signs at screening visit and eligibility con- firmation visit. Dr. Asbell detailed the specific inclusion and eligibility criteria for the study and discussed the treat- ments. Participants had five softgels per day, and careful consideration was given to ensure that those used in the active and placebo groups were identical in size, color, and aroma. Patients were enrolled through 27 clinical centers in the U.S. from October 2014 to July 2016, with 923 patients screened and ultimately 535 randomized patients. The change in OSDI was the primary outcome measure, Dr. Asbell noted. The DREAM study showed that an oral omega-3 is no better than placebo in relieving signs and symptoms of dry eye disease. Dr. Asbell noted that although there was improvement, there was no signif- icant difference between the active and placebo groups. At 3 months, both groups improved when looking at the OSDI score, but there was no significant difference between the placebo and active groups. Looking at second- ary outcome measures, Dr. Asbell said that the signs were marginally improved, but this was equally true in both groups. Dr. Asbell noted the study's many strengths, including its generalizability (use of real world patients), comparability of groups, compliance, treatment, and consis- tency. Edward Holland, MD, Cincin- nati, presented on "Artificial Corneal Transplantation: What's the Future?" We've seen tremendous progress in corneal transplantation, he said, but there are still major problems/ challenges, including worldwide blindness, high risk keratoplasty, and severe ocular surface disease. Dr. Holland noted that there are 2 million new corneal blindness cases a year. Why the need for an artificial cornea? Dr. Holland said current eye banking methods and placement of human donor corneas have major deficiencies. There is a vast shortage of donor corneal tissue worldwide, he said, particularly noting that do- nor tissue is not readily available in developing countries. Storage time for donor tissue is limited; it cannot be used to treat LSCD and severe OSD, and there is a lifetime risk of immune rejection and endothelial failure. Dr. Holland spoke about the ar- tificial cornea technology currently available: AlphaCor (CooperVision Surgical, Lake Forest, California), the Boston KPro (Massachusetts Eye & Ear Infirmary, Boston), the os- teo-odonto-keratoprosthesis (OOKP), and the KeraMed (Orange, Califor- nia) KeraKlear artificial cornea. EW Editors' note: Drs. Asbell and Holland have no financial interests related to their presentations. Ocular surface advances highlighted at Cornea Day Dr. Asbell discusses results of the DREAM Study. continued on page 14

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