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Ophthalmologists need to be aware of alternatives surrounding penetrating keratoplasty
CHICAGO — General ophthalmologists and anterior segment surgeons alike need to be aware of alternatives to penetrating keratoplasty, one surgeon said here.
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"The comprehensive ophthalmologists and cataract and anterior segment surgeons need to know what we're doing now because a lot of these patients aren't referred in because [the physicians] don't know that there's procedures that benefit them," said Edward J. Holland, MD, during the Binkhorst Lecture at the Opening General Session of the annual American Society of Cataract and Refractive Surgery meeting.
Anterior segment surgeons have faced a number of potential complications with the penetrating keratoplasty procedure. "All of us deal with the high regular as well as irregular astigmatism, the unpredictable corneal power and the poor wound healing that leads to delays in visual recovery up to 9 to 12 months for our patients," said Dr. Holland.
He outlined anatomic-targeted procedures developed over the last decade that serve as alternatives.
Surgeons can now perform Descemet's stripping endothelial keratoplasty for patients with endothelial failure and deep anterior lamellar keratoplasty for patients with corneal and stromal disease. There are also new technologies that make penetrating keratoplasty more efficient and effective such as large-diameter grafts, laser vision correction and femtosecond-assisted and sutureless procedures.
Additionally, ocular surface stem cell transplantation is available for patients with severe loss of limbal or conjunctival cells from trauma or inflammation. Stem cells can be derived from living relatives, cadaveric donors and the patient's own eye.
"Please be aware of these procedures and make the appropriate referrals," said Dr. Holland.