Cornea
September 2023
by Julie Schallhorn, MD
Cornea Editor
“First, do no harm.” This vow forms the underpinning of the Hippocratic Oath, which we, as physicians, have all sworn to uphold upon graduation from medical school. On the surface, this seems so obvious as to be almost blasé—what physician would want to cause harm to their patient? But in practice, this is not so straightforward.
Innate to the concept of performing an intervention to treat a patient is the possibility of developing a complication. Though not intentional, a physician still bears the heavy responsibility of managing the untoward harm and navigating to the best possible outcome. With every new treatment and surgical procedure that enters our armamentarium comes an array of associated potential complications. To truly prevent harm, one needs a thorough knowledge of the potential problems that may occur and the best way to treat them.
There are cases where everything is technical perfection, where things can’t go more right in surgery, and still the patient can develop a poor outcome. As surgeons, our responsibility to our patients is to anticipate these situations and be prepared to manage them to the best of our ability.
It is well established at this point that lamellar keratoplasty offers numerous advantages over a full thickness graft for the treatment of endothelial disease. In this issue’s excellent article on graft-associated interface infections, we can see a chief example of a novel issue caused by a surgical procedure that undoubtedly offers great benefits. The management is not so straightforward, and I encourage you read to hear the excellent recommendations from Elmer Tu, MD, and Barry Lee, MD.
Likewise, surface ablation for the treatment of refractive error has benefited millions of people worldwide. Corneal haze is a rare but debilitating potential complication that has not had great therapeutic options, and management has been focused primarily on prevention until now. Steven Wilson, MD, has done extensive research and study on a breakthrough therapy in the form of topical losartan, which is the focus of the first outstanding article in this section that is a must-read for any corneal surgeon.
Rounding out this quarter’s offerings is an overview of corneal ring segments and their use in the treatment of ectasia, with discussion from Philip Dockery, MD, MPH, Soosan Jacob, MD, and Aylin Kiliç, MD.
Being a surgeon is truly a humbling experience. There are cases where everything is technical perfection, where things can’t go more right in surgery, and still the patient can develop a poor outcome. As surgeons, our responsibility to our patients is to anticipate these situations and be prepared to manage them to the best of our ability. I myself am truly thankful for experts, like those who have contributed to this issue, whose thoughtfulness and diligence enable me to provide better care when complications happen.
