SPECIAL REPORT

Introduction to the Cornea Report 2012

By Thomas John, MD, Guest Editor

In 2012, our mindset on the to the human cornea needs to be reset. Moving away from a whole-cornea-approach to a corneal-layer-approach may be facilitated by newer surgical techniques and advanced laser corneal applications. Biomechanically, the anterior cornea may be viewed as the epicenter of corneal strength as compared to the posterior cornea. This Special Report focuses on newer corneal advances that can further optimize our eye care delivery.

Corneal imaging is an integral part of corneal evaluation. To review this arena of available technologies, Dr. Sheppard and Mr. Gazzolo describe a selection of various imaging devices and their clinical applications and address the million-dollar-question of “to buy or not to buy?”

Two major categories of importance to eye surgeons are inflammation and infection. Drs. Schell and Kaufman cover ocular inflammation in general and specifically focus on staphylococcal marginal keratitis, PUK and Mooren's ulcer. Dr. O'Brien then describes current treatment approaches to corneal infections and provides a glimpse at future treatment modalities on the horizon. Moving on, we addressg ocular allergy, both seasonal and perennial. Dr. Devgan dissects this topic and provides a practical approach to managing ocular allergy. Ocular surface issues and dry eyes are of interest to general ophthalmologists, cornea specialists and refractive surgeons. This is because ocular surface optimization provides the best quality of vision and, in 2012, it's all about the quality of vision. Tear film, lids and the corneal surface, all play a unified role in post-operative patient satisfaction. Equally important is the general health of the eyelids. Posterior blepharitis can potentially contribute to tear film destabilization and make our patients more symptomatic, which can lead to increased office chair-time. Hardten and colleagues, describe therapeutic approach for effective management of meibomian gland dysfunction and blepharitis. Another challenge is the management of neurotrophic keratitis, persistent epithelial defect, corneal melt and possible corneal perforation. Dr. Kenyon describes the therapeutic advances in neurotrophic keratitis. Although some of these newer treatments are not yet FDA-approved, they're expected to be available in the future.

In the surgical space, femtosecond laser is a major player with its expanding surgical applications in corneal transplant, astigmatism correction, intracorneal ring and modern-day cataract surgery. Dr. Steinert, a pioneer in ophthalmic laser work, provides an in-depth perspective of femtosecond laser applications in corneal surgery. Finally, yet another exciting area is the ever-changing corneal transplantation scene, evolving from DLEK, to DSAEK to DMEK. Although, the majority of corneal surgeons and their patients are quite pleased with DSAEK results, I describe DMEK and why DMEK will ultimately overthrow DSAEK. Such changes demand DMEK simplification to facilitate easy duplication, and timely adoption by majority of corneal surgeons.

In summary, the positive response to our debut Cornea Report last year has led to this second 2012 Special Cornea Report. This report is aimed at providing useful coverage of some of the cutting-edge advances in the corneal space in the hopes that some clinicians will consider embracing and applying these newer diagnostic instruments and treatment approaches to improve the corneal health of our patients and potentially improve their quality of life, as well. ■