Corneal research papers catch the experts’ attention

Presentations on changes in corneal transplant techniques and recent onset corneal neovascularisation by two Moorfields ophthalmologists won best in paper conference awards at the American Academy of Ophthalmology. It is the largest meeting in the world for the profession.

The presentations which received the coveted best paper ribbons were given in the corneal and external diseases sessions by Mr Romesh Angunawela - consultant in cornea, external disease cataract and refractive surgery - and vitreo-retinal fellow Mr Kam Balaggan.

Changes in techniques for corneal transplants were the subject of Mr Angunawela’s presentation on a paper he originally co-authored with Mr Bruce Allan and Maninder Bhogal. Entitled the “Theoretical, experimental, and OCT study of factors affecting graft apposition and adhesion strength in descemet-stripping automated endothelial keratoplasty”, it was the most highly rated in the corneal external diseases part 1 session at the conference.

Outlining why it was selected for a best paper ribbon, Mr Angunawela said: ”For the first time it gives scientific evidence proving that changes to the techniques we use in corneal transplant surgery can have a direct impact on better results and outcomes for our patients.” The research itself was the result of collaboration between Moorfields, the Department of Mechanical Engineering at UCL and the Nanoforce Unit at Queen Mary's University. 

Catching the experts’ attention in the part II session was Mr Kam Balaggan’s presentation on Recent Onset Corneal Neovascularisation and the Use of Subconjunctival Bevacizumab.

In his paper, Mr Balaggan presented the results of the world’s first randomised controlled clinical trial of the use of bevacizumab for corneal neovascularisation, for which Mr Steve Tuft was the Chief Investigator. Corneal neovascularisation is characterised by abnormal and unwanted growth of blood vessels in patients into the otherwise normally transparent cornea. This results in impaired vision and can significantly reduce the chances of the long-term success of corneal transplant surgery. The judges said they “were impressed by the quality of the study including the study design and the results, and the quality of  the presentation and of the replies to the questions from the audience.” 

Although Mr Balaggan’s specialism is in vitreo-retinal surgery, his research background is in targeting unwanted angiogenesis (abnormal blood vessel growth in the eye), and the bevacizumab study was one he co-proposed and later contributed to the design of whilst working as a registrar several years ago.  

Notes to editors:

Titles of best papers 

• Cornea, External Disease session—Part I. Theoretical, Experimental, and OCT Study of Factors Affecting Graft Apposition and Adhesion Strength in Descemet-Stripping Automated Endothelial Keratoplasty, by Romesh I. Angunawela, MBBS, (Maninder Bhogal was unable to attend) (event code PA035) 
• Cornea, External Disease session—Part II. A Randomized Double-Masked Placebo-Controlled Evaluation of Subconjunctival Bevacizumab for Recent Onset Corneal Neovascularization, by Kamaljit S. Balaggan, MBBS (PA044
• Mr Angunawela has been a consultant at Moorfields Eye Centre at St George’s Hospital and at the main hospital in City Road since 2005. He completed fellowships in corneal and external disease at Moorfields and in Singapore and also studied under Professor John Marshall MBE at Guys and St Thomas’s to complete a doctorate in corneal wound healing after laser eye surgery, an area in which he retains an interest. He was recently made a senior honorary lecturer at St Georges.
• In Milan last September at the Eucornea meeting he presented a paper on the subject of manual suction versus femtosecond laser trephination for penetrating keraoplasty which was co-authored with Jodhbir Mehta and Donald Tan. This paper  also won a best paper award for demonstrating  what happens to intraocular pressure during various types of trephines used for corneal transplantation  and also demonstrated that trephination with a femtosecond laser causes less cell damage, gives a more precise cut and causes less pressure increase. The title of the paper was Manual suction versus femtosecond laser trephination for penetrating keratoplasty: intraocular pressure, endothelial cell damage, incision geometry, and wound healing responses. Meeting: Eucornea, Milan 2012 Authors: Romesh Angunawela, Jodhbir Mehta, Donald Tan. 
• Mr Kam Balaggan has worked in both research and clinical roles at Moorfields and the UCL Institute of Ophthalmology since 2002. Mr Balaggan has completed a PhD at the UCL Institute of Ophthalmology under the supervision of Professors Robin Ali and James Bainbridge, investigating novel Gene Therapy strategies to provide a single-treatment “cure” for wet age-related macular degeneration (AMD). His work contributed to the development of new, safer gene therapy vectors, and he also contributed to Moorfields’ clinical gene therapy trial for childhood inherited blindness. He is currently the Principal Investigator for a clinical trial to be initiated at Moorfields later this year, evaluating the use of a new radiotherapy device for AMD.
• Moorfields is one of the world’s leading eye hospitals, providing expertise in clinical care, research and education. We have provided excellence in eye care for more than 200 years and we continue to be at the forefront of new breakthroughs and developments.  We are an integral part of one of the UK’s first academic health science centres, UCL Partners, and were one of the first NHS organisations to achieve foundation trust status in 2004.  
• We treat the entire range of eye diseases, from common complaints to rare conditions which require treatments not available anywhere else in the UK. We dealt with more than 475,000 patient visits in 2011/12 at our main hospital base in London’s City Road and at 19 other sites in and around the capital, enabling us to provide expert care closer to patients’ homes.
• With our research partners at the UCL Institute of Ophthalmology, we run one of the largest ophthalmic research programmes in the world and have the highest measure of scientific productivity and impact in the world for our research activity. 
• For further information, please visit www.moorfields.nhs.uk.