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Endothelium preservation plays key role in keeping postop corneas clear
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 Roger F. Steinert |
SAN DIEGO — Preserving the endothelium is among the most critical factors in keeping the cornea clear after surgery, a presenter said here.
"This subject really begins with a focus on ophthalmic viscosurgical devices," OSN Cornea/External Disease Board Member Roger F. Steinert, MD, said during Cornea Day, which preceded the American Society of Cataract and Refractive Surgery meeting. "They maintain the corneal dome, which helps prevent damage from instruments and cell damage from flexion. They also provide a barrier against nuclear fragments, ultrasound mechanical injury, heat damage and oxidative species damage."
Current literature offers a number of conflicting views on OVD retention, and published findings are all dependent upon the methodology used, according to Dr. Steinert. However, it can be concluded that low-flow techniques contribute to the retention of OVDs and hydroxypropyl methylcellulose better than higher-flow techniques.
Other techniques that appear to limit endothelial damage include mechanically assisted techniques to reduce the total ultrasound energy used during a procedure, performing as much phaco as possible deeper into the capsular bag, and replenishing OVD at least once during surgery — a method that is also much cheaper than performing Descemet's stripping endothelial keratoplasty, according to Dr. Steinert. Additionally, maintaining meticulous OR protocols can be just as important.
"Make sure to catch the little 'misbehaviors' as one technician teaches another technician [and so on]," Dr. Steinert said. "Deviations from good protocol can creep in, and you want to try to anticipate that and head it off before you have a full-blown [toxic anterior segment syndrome] outbreak."
- Disclosure: Dr. Steinert is a consultant to AMO and Alcon, and has provided instrument designs for Rhein Medical.