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BLOG: Here’s to the corneal innovators
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In this issue of Ocular Surgery News, our cover story focuses on the evolving understanding of the cornea as it relates to endothelial replacement surgery. I’d like to reflect on the incredible innovation that has led to these procedures.
About 10 years ago, I remember attending the very earliest meetings of the “Endothelial Keratoplasty Group” at the AAO and ASCRS meetings. This group, organized by the very young Mark Terry, would gather to discuss best methods for performing deep lamellar endothelial keratoplasty. Gerrit Melles had first described this technique in which surgeons use specialized scissors and dissectors to create a total corneal pocket and then remove the posterior one-third of the stroma, replacing it with a similarly dissected posterior disc from a donor cornea that would be tucked into this pocket. In those ugly, early days, we saw frequent cases of primary graft failure and donor dislocation, and we frequently converted to penetrating keratoplasty, the standard procedure of the day for endothelial replacement.
We performed all of these procedures under an IRB protocol to closely watch our results. When eye banks began providing precut donor disc tissue, particularly with laser-assisted cuts, the procedure became entirely more consistent than with hand-dissected donor tissue crafted on an artificial anterior chamber.
A big leap forward occurred when Melles next described Descemet’s stripping endothelial keratoplasty, in which only Descemet’s membrane was removed from the recipient tissue, and we learned that a donor disc of endothelium and thin stroma would stick itself to the inside of the cornea.
Today, we routinely perform Descemet’s membrane endothelial keratoplasty, in which only Descemet’s is transplanted, reducing further the complexity, trauma and tissue alteration of surgery. Frank and Marianne Price, another duo of incredibly devoted innovators, have shown us that this new procedure reduces rejection 10-fold and helped us all understand how to perform these procedures safely.
Although I’ve named a few here, I can’t possibly recognize all of the innovators who deserve credit for the evolution of these amazing procedures. With no industry sponsorship, they have transformed the lives of now hundreds of thousands of patients through the hands of corneal surgeons. It’s an inspiring bit of history that some of us have been lucky enough to observe first hand.
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.