Revolution in care

Major developments have helped improve the standard of treatment for corneal diseases

Jesper Hjortdal

Posted: Sunday, April 1, 2018


The last 15 years have revolutionised the medical and surgical treatment of corneal and ocular surface diseases. The development of new lamellar techniques for treatment of endothelial diseases (DSAEK and DMEK) and diseases involving the corneal stroma (DALK) has meant a major improvement in the healthcare of patients with corneal diseases: Patients have faster visual recovery, a more stable and stronger eye and less risk for immunological rejection episodes.

Similarly, the use of serum eye-drops, amniotic membranes, new drug developments and improvement in medical contact lenses have significantly reduced the disease burden in patients with ocular surface diseases.

During the same time period, “new” corneal diseases have become more common in Europe (fungal and acanthamoeba keratitis) and new iatrogenic diseases have been discovered (ectasia after LASIK, and graft-versus-host disease after bone-marrow transplantation).

These major changes in corneal healthcare require ophthalmologists in general and corneal specialists in particular to continuously keep updated on new diagnostic methods and new treatment modalities. The Cornea Day at the ESCRS Winter meeting organised by ESCRS in collaboration with EuCornea and the EuCornea annual meeting in the autumn are two good opportunities for this.

The annual Cornea Day was held this year on Friday 9 February during the ESCRS Winter Meeting in Belgrade. José Güell from EuCornea and Rudy Nuijts from ESCRS had jointly organised the four programme sessions, each composed of a keynote lecture followed by several case presentations.

The session on ocular surface disease included a keynote lecture on Meibomian gland dysfunction and interesting case reports on various topics such as the effectiveness of compressive sutures in management of acute hydrops and the use of corneal lenticules from ReLEx SMILE surgery for the treatment of corneal ulcers.

The second session on management of corneal complications after refractive surgery was opened with a keynote lecture on how to deal with induced astigmatism, followed by a wide variety of case presentations on coping with corneal femtosecond laser complications, corneal ectasia and epithelial ingrowth after phakic IOL implantation.

Tips and pitfalls in corneal graft surgery was the topic of the third session, and after the keynote lecture on long-term results of DALK or PK for keratoconus, the case presentations covered almost all types of keratoplasty, including a new DMEK loading technique, timing of DMEK, coping with retained Descemet’s membrane after PK and corneal melting after Boston KPro implantation and using a lamellar autologous graft in acute transplantations when donor tissue is unavailable.

In the last session, focus was on infectious keratitis. In the keynote lecture clinical points on discriminating between sterile and infectious interface inflammation were presented, and the following presentations included difficult cases with keratitis caused by atypical mycobacteria, leptospirosis, acanthamoeba and fusarium.

Overall, the Cornea Day was very well attended and the meeting in Belgrade perfectly organised.

In September, the Board and Programme Committee of EuCornea look forward to welcoming residents and colleagues to the beautiful city of Vienna where the 9th EuCornea Congress will take place 21-22 September 2018. The programme will include seven symposia and six courses. The topics include symposia updates in fungal keratitis, ocular surface inflammation, management of keratoconus and current trends in keratoplasty, while the headlines for the courses comprise handling of difficult cases in lamellar surgery, gluing, management of surface tumours, keratoprostheses and indications for therapeutic contact lenses.

To keep you updated with the newest advances in management of ocular surface and corneal diseases, we look forward to seeing you in Vienna in September!

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