Latest Advances in Corneal Surgery

Dear Colleagues,

Over the last decade, there have been a number of advances in corneal surgery. The most significant advances have been in “Selective Corneal Transplant Surgery”. Historically, most patients who had vision-threatening corneal diseases required full thickness penetrating keratoplasties. Now, we selectively pick the type of transplant for the patient based on their underlying disease. Endothelial keratoplasty, either DSEK (Descemet’s stripping endothelial keratoplasty) or DMEK (Descemet’s membrane endothelial keratoplasty), will be used for patients with endothelial disease, such as Fuchs’ dystrophy or corneal edema. Some patients may benefit from DSO/DWEK (Descemet’s Stripping without endothelial keratoplasty). Maybe someday the injection of cultivated corneal endothelial cells will replace all of these procedures.

DALK (deep anterior lamellar keratoplasty) can be used for those patients with anterior corneal scarring, such as keratoconus or infectious keratitis. Full-thickness penetrating keratoplasty remains the choice for those patients who have severe diffuse corneal disease. Along with advances in specific surgical techniques, we have also had advances in corneal imaging that can help us determine which technique is best for our patients.

Though most of the research has been carried out on optimizing selective corneal transplant surgery, there have been advances in the surgical options for patients who are not candidates for selective keratoplasties. Patients with limbal stem cell dysfunction and severe ocular surface disorders are often not candidates for any type of corneal transplant surgery. These patients can sometimes benefit from limbal stem cell transplants or keratoprosthesis. Our experts will evaluate and discuss how patients with these diseases can benefit from these forms of corneal surgery.

The other revolution has been in the treatment of keratoconus. Keratoconus is the disease that, for many years, was considered the second most common reason for corneal transplant surgery. The treatment of keratoconus has seen major changes over the last seven to ten years. Ten years ago, patients with severe keratoconus who were contact lens-intolerant could only have transplant surgery. Collagen cross-linking has revolutionized the treatment of keratoconus, often a severe and disabling disease in young people. If keratoconus is diagnosed early, collagen cross-linking may halt or stabilize the disease, therefore avoiding the need for transplant surgery. With our experts, in this Special Issue, we will discuss the advances and changes in collagen cross-linking and its use in keratoconus patients.

Dr. Gerald W. Zaidman
Guest Editor

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