Endothelial keratoplasty procedures continue to evolve

SAN DIEGO — Surgeons have become more precise transplanting less tissue, keynote speaker Francis W. Price Jr., MD, PhD, said in an address on the evolution of endothelial keratoplasty at the World Cornea Congress.

“Endothelial keratoplasty is a disease-specific surgery relative to PK. We only replace the dysfunctional part of the cornea,” he said. “We get better visual results than PK and it’s safer for patients.”

Francis W. Price Jr.

“As we get smaller incisions, we get better vision and safer surgery,” Price said. “In fact now many of our patients are 20/20 to 20/40 corrected vision on day 5, and a number of our patients are opting to have their second eye done 1 to 2 weeks after the first. That is a huge change for transplant surgery.”

Endothelial keratoplasty has evolved greatly over the past 10 years, representing only 4.5% of grafts in 2005 in the U.S. and now representing more than 50%. Several “givens” of endothelial keratoplasty principles and practice have also changed over the years. For example, today guttae are seen to decrease vision, a change from traditional thinking in 2005, he said.

“You don’t do your Fuchs patients a favor by only doing phaco without removing the guttae, and you don’t need to wait a year between eyes if you’re doing DMEK,” Price said.

Furthermore, older donors are better than young ones for DMEK.

“That’s a big change,” Price said. “I think people had a hard time believing that at first.”

A previously underappreciated thought is that stromal tissue is important for immune recognition, he said.

With regard to glaucoma, Price said vision can be improved with endothelial keratoplasty and that tubes have a worse effect on the cornea than trabeculectomies.

“[Tubes] have poorer survival rates and there’s more intense changes in the anterior chamber protein,” Price said. - by Patricia Nale

Disclosure: Price reports relevant financial disclosure with regard to Bausch + Lomb.