ASCRS 2024: Highlights from a corneal case report of a patient undergoing the triple procedure

Elizabeth Yeu, MD, discusses a case report for how the triple procedure can be beneficial for different patient populations in her ASCRS presentation, 'Human corneal endothelial cell transplantation combined with cataract extraction and PCIOL in subject with corneal edema.'

Video Transcript

Editor's note - This transcript has been edited for clarity.

Elizabeth Yeu, MD: Hi, my name is Elizabeth Yeu. I'm a cornea, cataract, and refractive surgeon at Virginia Eye Consultants. I have been so fortunate to be involved with the Aurion clinical trials, which we were able to do the phase 1 and 2 studies in El Salvador to make sure that we were looking at the human corneal endothelial cells [CEC] with a proprietary ROCK [rho-kinase] inhibitor and find out the right dosing. But at the same time, we were also able to help with different patient populations.

In doing so we were able to help certain patients, for example, an 85-year-old patient who had a very significant cataract with 20/800 vision and a 700-micron cornea. And this patient certainly needed to have some kind of procedure where we could take care of both at the same time. In the US, obviously, this would be a patient that's standard of care who would absolutely be considered an an EK [endothelial keratoplasty] procedure at the same time with a combined cataract surgery. So absolutely recognizing that having done multiple corneal endothelial cell injection therapy patients and seeing the results of that, we said, well, absolutely, let's do the cataract surgery and consider a triple procedure, see how this patient does because we know how successful the CEC therapies have been for our patients.

So thus, we did perform for this 20/800 patient with a significant cataract and a thickened cornea, a triple procedure doing the phacoemulsification and the human corneal endothelial cell injection therapy that also had the ROCK inhibitor.

And lo and behold, absolutely wonderful results that we could see. In terms of any differences in the way that surgical procedure was performed, absolutely not. Just a routine cataract surgery for a mature brunette lens. And at the end of the procedure, we perform the normal injection therapy of the cells as we normally would have after bringing the pupil down.

And after 2 months, there was a 200 micron decrease in the corneal thickness from 700 microns down to 500 microns. And the patient by postop month 6, there was gradual improvement of vision. But the patient by postop month 6 was 20/25 with a 500-micron cornea from limbus to limbus.

These patients look like none other. It is completely different than the kind of patients we see with allograft postoperative cadaveric donor corneas, because it is not just clearing of the central 70% of the cornea. It is limbus to limbus clearing and 500 microns of glistening pure clearing of the full 11 to 12 diameter cornea.

It is completely life altering for these patients that we see postoperatively and it just makes you realize that we are going to be able to potentially change the way that we are able to help our patients in the US, in the future, globally as well, for our visually significant cataracts who also have have visually significant endothelial disease.

It's very promising therapy for both our pseudophakic as well as our phakic patients who have significant endothelial damaged corneas. Thank you.