Dr. Parag Majmudar on the Impact of Collagen Crosslinking and DMEK
Dr. Parag Majmudar on the Impact of Collagen Crosslinking and DMEK
Dr. Parag Majmudar reviews highlights of the 2008 ASCRS meeting in a discussion with Dr. William Trattler. Corneal collagen cross-linking with riboflavin + UVA shows great potential for the treatment of ectasia and keratoconus. This has tremendous potential to treat early stage keratoconus patients so that they may be eligible for refractive procedures. Endothelial keratoplasty is another hot-topic having gone from DLEK to DSEK and possible moving to DMEK (Descemet's membrane only) in the future. Initially, his DSEK procedure followed that of Francis Price, MD, with preparation of donor tissue. Dr. Majmudar has recently switched to using pre-cut donor tissue, but finds that tissue thickness standardization is still an issue. Femtosecond technology may remedy this soon. Has used 60/40 fold, tri-fold, and glides for insertion of donor tissue into the anterior chamber. The goal is the preservation of the endothelial cell layer and ensuring better visual outcomes. DMEK is another hot topic. Pioneered by Garrit Melles, MD, DMEK is based on the idea that stromal dissection isn't required, allowing you to implant only Descemet's membrane into the anterior chamber. Using non-air gases such as octafluoropropane (C3F8), or sulfur hexafluoride (SF6) may aid in prevention of graft dislocation.