Corneal Transplantation: Transitioning to PDEK (Pre-Descemet’s Endothelial Keratoplasty)

By |May 28th, 2017|Corneal Transplants|0 Comments

Corneal Transplantation has undergone several advances over the past 2 decades.  From full thickness penetrating keratoplasty (PK) to Deep Lamellar Endothelial Keratoplasty (DLEK – Dr. Mark Terry), Descemet’s Membrane Endothelial Keratoplasty (DSEK – Drs. Garrett Melles and Frank Price), DSAEK (“A” for Automated – Dr. Mark Gorovoy), Descemet’s Membrane Endothelial Keratoplasty (DMEK – Drs. Garrett Melles and Frank Price) and now, Pre-descemet’s Endothelial Keratoplasty (PDEK – Dr. Amar Agarwal).

The goal with PDEK is to offer a procedure that takes the advantages of DSAEK (younger donor tissue, fewer re-operations, shorter surgical learning curve, intraoperative surgical predictability, robust tissue suitable for manipulation) […]


The Cataract Patient That Also Has “Dry Eye”

By |March 2nd, 2017|Blog, Corneal Transplants, Dry Eye, Duke Eye Center|0 Comments

A striking percentage of patients needing eye surgery, particularly cataract surgery have the signs and symptoms of preexisting “dry eye” consisting of tear film instability, rapid tear breakup time, ocular surface disease – all resulting from inspissated secretions clogging meibomian glands leading to blockage and dysfunction.  The single most effective treatment in my practice involves a pre-treatment preparation of the glandular openings followed by a painless, 12-minute treatment delivering vectored thermal pulsation.  A treatment that I did earlier today is best represented by the attached video of a patient who underwent successful treatment a year ago and now is back […]


Muro 128: What is it and how did it get that name?

By |February 18th, 2017|Blog, Corneal Transplants, Other Eye Conditions|0 Comments

I want to credit the insight given to me from Dr. Doug Rett, OD, FAAO:

“In 1958 Muro Pharmacal Labs was founded and it manufactured ophthalmic drugs. It was named Muro for the Italian word for “wall,” which I think is fitting given the barrier that the cornea plays in penetration of ocular drugs. With tight junctions, pH sensitivity and the hydrophobic nature of the epithelium and hydrophilic nature of the stroma, it’s difficult for modern-day drug companies to pass medication through the cornea, let alone in the 1950s. In 1968 Muro was sold to George Behrakis, a pharmacist from Lowell, […]


Corneal “Hydrops” – What is it and how did it get that name?

By |February 16th, 2017|Blog, Corneal Transplants, Keratoconus|0 Comments

Corneal hydrops involving a rupture or break in Descemet’s membrane is a relatively uncommon event occurring in patients with advanced keratoconus or other or corneal ectasia  – possibly caused by aggressive eye rubbing – is characterized by stromal edema due to leakage of aqueous humor through a tear in Descemet’s membrane.  It was the Greek physician Hippocrates (ca. 460 BC–370 BC) who is often credited with developing the theory of the four humors—blood, yellow bile, black bile, and phlegm—and the influence of these “fluids” on the body and its emotions.  Swelling associated with disease became known as oidêma (swelling) and […]


Needle Driver Designed to Make Eye Surgery More Precise and Efficient

By |February 16th, 2017|Cataracts, Corneal Transplants, Duke Eye Center, Uncategorized|0 Comments

While much of our surgery in Ophthalmology has moved away from needing sutures, there are still procedures that require very delicate suturing, including corneal transplant procedures, deep anterior lamellar keratoplasty, traumatic injuries, sutured intraocular lens implants, and other procedures.  I am grateful to Doug Mastel and the great folks at John Weiss & Son International for their help in bringing into production the Carlson-Troutman needle holder that serves as an extremely precise needle driver while simultaneously serving as a tying forcep – allowing the passage of a needle and also tying the suture without exchanging instrumentation – improving efficiency, precision, […]


Duke Eye Center Links Obstructive Sleep Apnea to Keratoconus

By |July 5th, 2012|Blog, Corneal Transplants, Duke Eye Center, Keratoconus|0 Comments

Research Digest
New & Noteworthy Journal Articles
Compiled by Andrew E. Mathis, PhD, Medical Editor
► Keratoconus and sleep apnea. Noting the sparseness of post-keratoplasty patients among their elderly patients, ophthalmologists Preeya Gupta, M.D., Assistant Professor of Ophthalmology and Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal Service at the Duke Eye Center in Durham, NC, undertook a study to determine whether there was any correlation between keratoconus and mortality, looking specifically at sleep apnea as a primary symptom. They report their findings in the June 2012 issue of Cornea.

The authors conducted telephone interviews with 101 patients diagnosed with […]


Ceremonial Ground-Breaking for New Duke Eye Center Clinical Facility

By |April 20th, 2012|Blog, Cataracts, Corneal Transplants, Dry Eye, Duke Eye Center, Glaucoma, Keratoconus, LASIK, Myopia, Refractive Surgery, Retina|0 Comments

Thanks to Bill and Kathy Hudson and LC Industries for their generosity toward the new state-of-the-art clinical Duke Eye Center in Durham, NC. 

From: Victor J. Dzau, M.D., Chancellor for Health Affairs; CEO, DUHS

Subject: Ceremonial Ground-Breaking for New Eye Center Clinical Facility

This morning we held a ground-breaking ceremony for a new, state-of-the-art Duke Eye Center building that will add much-needed clinical examination space and enhance the patient experience.

The ceremony celebrated the team effort that has turned this dream of building a new Eye Center clinical facility into a reality. Thanks to the collaborative efforts of our legion of generous donors, […]


The Dry Eye Patient 4-Months After LipiFlow Thermal Pulsation Therapy

By |February 18th, 2012|Blog, Cataracts, Corneal Transplants, Dry Eye, Duke Eye Center, Keratoconus, LASIK|0 Comments

Early results representing my clinical observations and also the subjective response of several patients after treatment have overall led me to believe that the LipiFlow Thermal Pulsation device from TearScience has been one of the most worthwhile additions to my clinical practice in recent years.  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC subspecializes in cataract surgery, corneal transplantation, and laser vision correction (LASIK) and as studied optimizing surgical outcomes for best practices and recognizes that the treatment of symptomatic dry eye syndromes is […]


Recent Advances is the Surgical Management of Keratoconus

By |February 16th, 2012|Blog, Corneal Transplants, Duke Eye Center, Keratoconus|0 Comments

Two of the most significant surgical advances now available for patients suffering from keratoconus who develop contact lens intolerance are Intacs instrastromal corneal ring segments (ICRS) and deep anterior lamellar keratoplasty (DALK) – both provide an alternative to full thickness (or penetrating) keratoplasty or corneal transplantation.  Many folks are going to immediately wonder about corneal collagen cross-linking and I am going to cover that later as “the jury” is still out and as I try to meticulously “connect the dots” of how people develop disease progression, I am less convinced that we will be doing cross-linking 10 years from now.  […]


Observations and Recommendations For Patients with Residual Astigmatism

By |February 15th, 2012|Blog, Cataracts, Corneal Transplants, Duke Eye Center|0 Comments





Are there mechanisms of which we can take advantage for patients with a high degree of astigmatism including residual, post-surgical astigmatism?  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC has observed that the astigmatic patient becomes particularly symptomatic under poorly lit conditions.  An example of this would include the “drop off” in quality of vision while driving at night under poorly lit conditions.  This might also include added eye strain with prolonged reading or computer usage.  This latter group of patients may benefit from […]