AN EXCITING TIME FOR CORNEA SPECIALISTS

The European Society of Cornea and Ocular Surface Disease Specialists (EuCornea) is still a very young organisation but overall we are very happy with the way things have been evolving. We are satisfied to have created a platform for people in Europe interested in cornea. There was a definite need for such a body and the two successful EuCornea meetings in Venice in 2010 and Vienna in 2011 reflected that there was indeed a real demand for exchange and education among corneal specialists in this part of the world. I am also involved in the Cornea Society in the United States and the perception over there is that Europe now has its own functioning cornea organisation which is making progress from year to year. They have been very supportive in our endeavours and were quick to see the potential for creating synergies between our organisations rather than considering us as direct competitors. We are grateful to them for their support and look forward to continued collaboration in the future.

Our plans are progressing nicely for the 3rd EuCornea Congress in Milan in September 2012. There were fears voiced in some quarters that aligning our meeting along with those of the ESCRS, EURETINA and the 2nd World Congress of Paediatric Ophthalmology and Strabismus might dilute our identity and overshadow our efforts to create a vibrant corneal society. The EuCornea view, however, is that the joint meetings are a positive development. Ophthalmologists have so many demands on their time and there is a perception that there are now too many meetings and congresses. Allowing delegates to attend a combined meeting is a more constructive use of their time and offers delegates the widest range of information in areas of overlapping interest. In this context, the 3rd EuCornea Congress in Milan is an opportunity to be seized and we look forward to building on the momentum that we have established in a few short years, thanks in part to the efforts of individuals such as our past president Vincenzo Sarnicola, our current president Harminder Dua, and not forgetting our president elect/vice-president Jose Guell who was instrumental in forging closer links with the ESCRS.

The timing for setting up EuCornea could not have been better. While traditional cornea was perhaps not the most dynamic field a decade ago, that has changed in recent years with an explosion of new techniques in lamellar corneal transplantation. This development has sparked a lot of interest in cornea and new techniques. The result is that surgical cornea has now become one of the fastest moving fields in ophthalmology. This is where EuCornea can play a fundamental role because there is a great need for education to accompany this surge in interest. There is a thirst for knowledge and a desire to learn as much as possible about new techniques, outcomes and concepts.

We are now seeing much more interest in the pathophysiology of the endothelium. Endothelium used to be very much a niche speciality with only a handful of people working in this area. Now it is very much in the mainstream because of the new developments in endothelial grafting. There are a lot of really exciting developments taking place in the field of cornea at the moment and EuCornea is ideally placed to take the lead in bridging the gap between basic science and surgery. I think the high attendance at the meetings in Vienna and Venice and the feedback from our delegates confirms that we are fulfilling this real need.

There are other potential roles for EuCornea in the years ahead. We could certainly play a more active part in regulatory issues and helping to ensure greater harmonisation of regulations and standards across different European countries. We could also be more instrumental in instigating and supporting clinical trials in the field of cornea, because there is a definite need for more evidence-based medicine. We could also take inspiration from landmark trials such as that instigated by the ESCRS concerning antibiotic prophylaxis of endophthalmitis in cataract surgery and see what could be done along similar lines for the field of cornea. There are also gaps in terms of nomenclature, surgical protocols, treatment guidelines and so forth, so these would be areas where EuCornea could definitely serve as a knowledge base for our members. However, while it is all well and good to be ambitious we must also be realistic and acknowledge that resources are limited at this point. That is why our goal for the moment is to focus on the meetings, and in particular our annual congress, and to use that platform to build a solid base for the organisation that will enable it to grow sustainably in the years ahead.

From a personal research perspective, one of the most exciting developments in corneal medicine over the past few years has been the evolution in Descemet’s membrane endothelial keratoplasty (DMEK) for the treatment of Fuch’s dystrophy and other endothelial diseases.  Since it was first described by Gerrit Melles, we have seen enormous improvement in the standardisation and application of DMEK techniques. This constitutes about 40 per cent of our graft indications and we have now successfully performed about 300 of these procedures. The rejection rates in our series are practically zero and other centres have also been reporting very promising results indeed with minimal complications. Progress is also being made in so many other areas of corneal disease, so it is a genuine privilege to be involved in such a rapidly evolving field at this moment in time.