January-February 2020


Best of ASCRS 2019: Cornea

by Liz Hillman Editorial Co-Director

Dr. Gupta presents at the Best of ASCRS 2019.
Source: ASCRS


The Best of ASCRS 2019 is a general session at the ASCRS ASOA Annual Meeting where members of the EyeWorld Editorial Board select what they think were the best papers in different categories from the meeting. They choose from the papers that were awarded Best Paper of Session in each individual paper session throughout the meeting and explain why they made their selections. Here we recap what those papers were in the Cornea category and why Preeya Gupta, MD, a member of the EyeWorld Cornea Editorial Board, thought they were noteworthy.

Visible meibomian gland structure increases after vectored thermal pulsation treatment in dry-eye patients with meibomian gland dysfunction

Arjan Hura, MD, Alice Epitropoulos, MD, Craig Czyz, DO, Caroline Blackie

Dr. Gupta introduced her first paper under the topic of meibomian gland dysfunction (MGD), setting the stage that gland atrophy occurs with chronic MGD and noting the assumption that gland atrophy is permanent.
This paper challenges that assumption, Dr. Gupta said.
This retrospective observational study involved 102 patients who were treated with vectored thermal pulsation and 32 who had only serial dynamic meibomian imaging and dry eye evaluations, serving as controls. At least a year after treatment, 70% in the experimental group showed improved visible gland structure, while 71% of those who did not have thermal pulsation showed worsening visible gland structure.
“I think as more and more people are getting meibography in their patients, we should have a framework to assess it, and if we’re helping to regenerate glands, to study that further,” Dr. Gupta said.

DMEK: Using younger donor tissue to reduce rebubble rates

Luke Potts, MD, Alex Bauer, BS, Khoa Tran, PhD, Shin-Yi Chen, MD, Michael Straiko, MD, Mark Terry, MD

While donor age has been presumed to influence rebubble rates and ease of surgery, Dr. Gupta said this paper challenges whether younger tissue can be used in DMEK procedures. The study included 977 DMEK surgeries (942 with older donor tissue [≥50 years old] and 35 with younger tissue [28–49 years old]). There was no statistically significant difference between younger and older donor tissue when comparing unscrolling time, mean endothelial cell loss at 6 months, and rebubble rate (though the rebubble rate was lower in the younger group).
Dr. Gupta said that while she won’t necessarily be asking for younger donor tissue, this study can provide confidence in the tissue if it is ever more available.

The impact of epithelial basement membrane dystrophy and Salzmann’s nodular degeneration on biometry measurements

Mark Goerlitz-Jessen, MD, Preeya Gupta, MD, Terry Kim, MD

“Ocular surface disease must be managed at the time of, or really prior to, cataract surgery,” Dr. Gupta said, introducing a paper that looked at the impact of nodules and epithelial basement membrane dystrophy (EBMD) on refractive outcomes.
This retrospective analysis included 39 eyes from 30 patients who were having a superficial keratectomy and/or phototherapeutic keratectomy for EBMD. Biometry was taken before the procedure(s) and again at least 30 days afterward. There was a statistically significant change after pre-cataract surgical intervention in mean keratometry and IOL power closest to zero. There was an IOL spherical power change and cylinder change for toric candidates for both EBMD and Salzmann’s after surgery to improve their ocular surface.
“When you look at how significant the change is, the greatest change was in the 0.75 to 1.5 D of astigmatism,” Dr. Gupta said, adding later that these findings drive home the importance of identifying and treating these conditions preoperatively.

Editors’ note: This session is available at ascrs.org/clinical-education/2019ondemand for those who attended the 2019 ASCRS ASOA Annual Meeting.

About the doctor

Preeya Gupta, MD
Associate professor of ophthalmology
Duke Eye Center
Durham, North Carolina

Relevant disclosures

Gupta: None


Gupta: preeya.gupta@duke.edu

Best of ASCRS 2019: Cornea Best of ASCRS 2019: Cornea
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