George Michael N. Sosuan, MD
University of the Philippines Manila - Philippine General Hospital
Philippines
In November 2025, I had the privilege of completing a clinical observership at the Department of Ophthalmology, Kyoto Prefectural University of Medicine (KPUM), made possible through the generous support of the Asia Cornea Society-Santen Educational Grant.
From the very first day, I felt welcomed and inspired by the academic environment. My observership began with a conference on limbal stem cell transplantation, where we discussed the Kinoshita Grading system. This set the tone for a well-structured and enriching program, and I am happy to share that I was able to fully meet my learning objectives throughout the observership.
My days in the cornea clinic with Dr. Koji Kitazawa and Professor Chie Sotozono were especially meaningful. I witnessed advanced management of severe bilateral Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid, and ocular surface burns using Cultivated Oral Mucosal Epithelial Transplantation (COMET). I also observed the clinical comparison between Acanthamoeba and Pseudomonas keratitis, the use of zigzag penetrating keratoplasty for keratoconus, and long-term follow-up of patients with sclerocornea and aniridia after COMET and PKP. At the keratoconus clinic, I gained valuable insight into Corneal Tissue Addition Keratoplasty (CTAK) screening and the management of keratoconus using rigid gas-permeable lenses and keratoplasty.
One of the most impactful experiences for me was attending the SJS clinic with Dr. Mayumi Ueta and Professor Sotozono. I observed patients being managed with limbal-rigid contact lenses, rebamipide, and cultures of eye discharge. The discussions emphasized the delicate balance between preserving normal ocular flora and the use of steroids, as well as the important role of oral cyclosporine in severe SJS cases. These sessions deepened my understanding of both the medical and human aspects of caring for patients with devastating ocular surface disease.
Dr. Osamu Hieda further broadened my exposure by sharing uncommon cases, including complex conjunctival masses and difficult corneal cases managed with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Meanwhile, Dr. Hideki Fukuoka exposed me to a wide spectrum of outpatient cases, including microsporidia keratitis, confirmation of epidemic keratoconjunctivitis using Rapid AutoAdeno for adenovirus detection, long-term follow-up of patients who underwent cultured endothelial cell injection therapy (Vyznova), cases of typical and atypical CMV endotheliitis, and the use of tacrolimus for Thygeson’s superficial punctate keratitis. Learning directly from these cases was both humbling and inspiring.
I was also very fortunate to observe state-of-the-art surgical procedures, including combined COMET, penetrating keratoplasty, and lens extraction with intraocular lens implantation, as well as multiple cases of cultured endothelial cell injection therapy (Vyznova). Seeing these advanced procedures firsthand greatly strengthened my understanding of complex surgical decision-making and reaffirmed my passion for cornea and ocular surface disease.
Sharing this journey with fellow observer Dr. Patriotika Muslima from Indonesia made the experience even more memorable. I am deeply thankful for the mentorship, generosity, and warmth shown to me by all the faculty, residents, and staff of KPUM. This November 2025 clinical observership has not only enriched my clinical knowledge and refined my management of complex corneal diseases, but has also inspired me to continuously strive for excellence in my practice and in the care of my patients.