Cornea Report 2014

Thomas “TJ” John, MD Guest Editor

The cornea is a small, complex, vital component of the eye that provides individuals with the gift of sight. In most developing countries in the world, corneal diseases represent the second leading cause of blindness¹ and globally there are around 4.9 million people with bilateral corneal blindness.¹ A focus on prevention and developing medical and surgical techniques to reverse corneal blindness is essential for every society.

This Cornea Report 2014 is a direct by-product of the first Advanced Cornea Conference (ACC) held in Ft. Lauderdale in March of 2014. ACC is directed to the practicing general ophthalmologist to provide a one-stop-knowledge-transfer conference that addresses both medical and surgical cornea in a state-of-the-art comprehensive manner, taught by the world’s leading experts in the field. ACC familiarizes the cornea specialists with all of the leading advances in the ever-changing fields of medical and surgical cornea. This must-attend cornea conference has been well received by attendees (from the United States and abroad), and we’ve recapped some of the key ACC presentations here to reach a larger audience for the benefit of their patients.

Kenneth Kenyon, MD, provides an overview of the clinical applications of the amniotic membrane to treat ocular surface issues including persistent epithelial defect and prevent its potential complications including corneal perforation and potential blindness. C. Stephen Foster, MD, provides comprehensive coverage of ocular cicatricial pemphigoid (OCP), emphasizing the importance of proper diagnosis of OCP before beginning systemic treatment with the most effective medication that has the least potential side effects for the particular stage of the disease process.

Moving on from the ocular surface to the interior of the eye, Perry Binder, MD, points out the importance of working closely with the surgical staff in taking steps to prevent toxic anterior segment syndrome (TASS).

I cover the changing faces of corneal transplantation from PKP to DSAEK, to DMEK with the emphasis on DMEK as the new and emerging endothelial keratoplasty procedure that is gaining rapid traction and interest.

Life-threatening ocular malignancies may present as everyday benign clinical entities so the clinician should be vigilant with a high degree of suspicion to detect these masquerading, cancerous entities, make an early diagnosis and refer to specialists for appropriate management. Failure to make the diagnosis in a timely fashion can result in unfavorable outcomes that may have a direct negative effect on the life span of the individual. Jerry Shields, MD, describes how lenticular astigmatism in a cataract patient can be due to an early-stage melanoma in the ciliary body.

Scheffer Tseng, MD, reviews both the clinical applications and recent advances in amniotic membrane transplantation to renew and restore the corneal integrity in various disease processes that affect the ocular surface while suppressing inflammation. The role of HC-HA/PTX3, a unique matrix, is also described. It’s interesting to note that myofibroblasts can be converted to neural crest cells and finally to corneal endothelium.

Yaron Rabinowitz, MD, highlights IntraLase-enabled keratoplasty (IEK) that can reduce the iatrogenic corneal astigmatism and pave the way to a faster recovery of best-corrected postoperative visual acuity.

Christopher Rapuano, MD, covers useful minor surgical procedures in the office setting that can help manage several ocular surface lesions including molluscum contagiosum, persistent epithelial defect, superior limbic keratoconjunctivitis and other conditions.

Uday Devgan, MD, shares with us three cases that highlight the importance of thinking on your feet and changing an unexpected intra-operative situation from going bad to an improved and manageable situation with a good surgical outcome and a happy patient.

Terry Kim, MD, describes the surgical use of the first FDA-approved tissue adhesive for sealing clear, corneal wounds during cataract surgery. His clinical study, run with polymer chemist Dr. Mark Grinstaff, showed the effectiveness of tissue adhesive in sealing clear corneal cataract surgery wounds and its superiority to corneal sutures based on the study criteria.

Medical and surgical cornea is ever changing with newer therapeutic modalities and surgical techniques that help combat compromised corneal and ocular surface diseases and improve the overall outcome for our patients with improvement in best corrected visual acuity and enhanced quality of vision.

Advanced Cornea Conference 2015, which is being held March 13-15 in Fort Lauderdale, will continue to provide a one-stop-learning experience of both the basics and newest advances in the field of cornea. I encourage you all to attend.

Regards,
Thomas “TJ” John, MD
Guest Editor, Cornea Report 2014

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