Contributions to Corneal Clarity

Happy New Year to all the readers of Eyeworld! I can’t think of a better way to start off the new year than an issue devoted to corneal surgery. Just in the last decade, we have witnessed unprecedented advances in corneal transplantation techniques heretofore unseen since the first reported corneal transplant by Dr. Edward Zirm in 1905 and the pioneering work of Dr. Ramon Castroviejo in the 1930’s-1970’s. The emergence of revolutionary lamellar procedures like Descemet’s stripping endothelial keratoplasty (DSEK) and deep anterior lamellar keratoplasty (DALK) as well as artificial corneal transplant procedures have undoubtedly changed the landscape of corneal transplant surgery. Innovative developments in instrumentation, femtosecond laser technology, and collagen cross-linking have allowed us to improve upon these surgical techniques to provide clearer corneas and better vision.
The series of articles on corneal transplantation review the current trends in corneal transplant techniques, provide interesting insight into why traditional penetrating keratoplasty still remains the mostly commonly performed transplant procedure, and describe the challenges and learning curves with DALK. They address the role of stem cell transplants and artificial corneas such as the Boston KPro, Alphacor, and the osteo-odonto-keratoprosthesis in high-risk patients with severe ocular surface disease and failed grafts. The commentary on endothelial transplantation focuses on the importance of endothelial cell loss and ways to minimize this loss. Specific attention is given to current surgical techniques as well as advances in donor tissue insertion and injector technology devices. Finally, the question of where we are with DMEK (Descemet’s membrane endothelial keratoplasty) and how it will impact patients and surgeons is also answered. And of course, no discussion of advanced transplant surgery would be complete without including the femtosecond laser and how this technology has changed how we cut the cornea altogether.
Novel therapeutic approaches have also surfaced through corneal cross-linking and pharmacologic treatments. Recent studies on the efficacy of cross-linking corneal collagen with riboflavin for keratoconus provide an optimistic update on how this technology is preserving vision and the structural integrity of the cornea. In addition to a new, more potent topical corticosteroid agent, we now have an FDA-approved ganciclovir gel that has been introduced for the treatment of herpetic keratitis.
So you can see that the cornea is certainly more than just a “dust cover” for the eye! Be sure to get the latest on these advancements and much more in Boston at the World Cornea Congress VI, which will take place on April 7-9, 2010, followed by the ASCRS Meeting on April 9-14, 2010. In the meantime, I hope you will enjoy the comments of our expert contributors and editors, to whom we are indebted to in making Eyeworld a valuable and high-quality publication.
I would also like to take this opportunity to thank the Editor Erem Latif and Chief Medical Editors Drs. Edward Holland, Stephen Lane, and Stephen Obstbaum for inviting me to provide this guest editorial, as well as the entire editorial staff for making this magazine a continued success.

Terry Kim, M.D.
Professor of Ophthalmology
Duke University School of Medicine
Editorial Board Member, Eyeworld