José Güell: Trends in Cornea Treatment

The World Cornea Congress convened on 21 March in Washington, DC, US, bringing together experts from around the world for a three-day examination of trends and developments affecting cornea care. EuroTimes talked to José Güell, head of the Cornea, Cataract, and Refractive Surgery Department at IMO Grupo Miranza in Spain, about the Congress programme and the key issues he sees in the field of cornea treatment.

How long have you been attending the World Cornea Congress, and why are you attending this year?

The World Cornea Congress takes place for two or three days and is performed every four or five years. The last time it met was in Chicago in 2019, just before COVID. I’ve been attending from the beginning—since it started.

I’m participating in a panel presentation titled “Two Decades of DMEK: What Have We Learned.” It was a special and difficult speaking invitation for me because, as a surgeon, it’s much better to talk about a particular surgical technique or the number of patients treated with this or that procedure. Anyway, it has allowed me to evaluate all we have accomplished along these years, and I must say it has been an extraordinary journey.

What do you see as the two or three biggest issues or trends today in the field of cornea treatment?

I would say one of the hottest issues is endothelial damage, both congenital and acquired, and its management. Today, DMEK—Descemet membrane endothelial keratoplasty—represents the standard of care for irreversible endothelial problems. This has been, as my lecture today points out, what we have been doing and improving for the last two decades.

But I think, as we start another decade, we will now be much more focused—and a lot of talks are being presented about it during this meeting—on cellular treatments. Cell culture techniques and cell injection techniques will definitely be the way to treat patients in the next few years.

Improving the positioning of the cells once injected inside the eye, and promoting and stimulating cell growth, will be what we will see in the next 5 to 10 years. Some of these treatments are already being investigated and implemented. So I would say that this is the hottest topic right now.

The second hottest topic, from my point of view—and also the subject of many presentations here—is the use of human tissue to be introduced into the corneal stroma in different ways, such as in the form of CAIRS, which means segments of the stroma instead of PMMA segments, which we have been using up to now. Another technique is SLAK, stromal lenticule addition keratoplasty. The use of human stroma, obtained from a human donor or through bioengineering techniques, is something that is getting relevant in the world of corneal surgery.

Third is the relevance of infections. This is nothing new because, as you will agree, it will be an issue not only in ophthalmology but [generally] for the next 30 years. So, at some point in the not-too-far future, cancer or tissue culturing will be controlled, but I think we will start suffering from new infections. And the eye is not an exception.

Infectious keratitis is an issue—it is becoming more frequent. Also, the distribution of pathogens is changing. Fungal infections, for example, were for many years a problem mostly in India and South America, but today, the number of fungal infections in the so-called Occidental World is significantly increasing. So there is a growing interest in new drugs for fungal infections, new antibiotics, and new drugs for parasites such as the Acanthamoeba.

Finally, I would say that artificial corneas, keratoprostheses, and its long term management, are also a hot issue. There are many other things I could mention, but this covers the main items.

How would you describe the response to these challenges? Is it fragmented, such as between Europe and the United States? Or is there a unified effort to address them?

I think we’re much more unified on cornea issues than on things like intraocular lenses. Many of the companies that are working hard on some of the things I just mentioned, like stimulators for cell growth and tissue cultures, are American. So this is an integration, a cooperation, between different corneal surgeons from around the world.

Does ESCRS have strong representation at the World Cornea Congress?

There are not too many ESCRS people here, as the main ESCRS focus is on cataract and refractive surgery. Béatrice Cochener-Lamard is here. She is a former president of the ESCRS and also the president of EuCornea. Mario Nubile is here; he is on the Programme Committee of the ESCRS. Sorcha Ní Dhubhghaill is here as well—she is the chair of the Cornea Committee and also a board member. And probably some other members are around.

Because anterior segment surgeons do at least some cornea work, we know there are a lot of ESCRS members with an interest in cornea. So we cover cornea topics on Cornea Day at our Annual Congress and in some courses and talks, but cornea is covered most thoroughly at EuCornea meetings.

Thank you for your insights, and good luck with your presentation.

I will do my best!

José Luis Güell MD, PhD is head of the Cornea, Cataract, and Refractive Surgery Department at IMO Grupo Miranza in Barcelona, Spain. He served as president of ESCRS in 2010–2011 and president of EuCornea from 2012–2014. guell@imo.es