Article Text
Abstract
Corneal endothelial diseases are leading indications for corneal transplantations. With significant advancement in medical science and surgical techniques, corneal transplant surgeries are now increasingly effective at restoring vision in patients with corneal diseases. In the last 15 years, the introduction of endothelial keratoplasty (EK) procedures, where diseased corneal endothelium (CE) are selectively replaced, has significantly transformed the field of corneal transplantation. Compared to traditional penetrating keratoplasty, EK procedures, namely Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), offer faster visual recovery, lower immunological rejection rates, and improved graft survival. Although these modern techniques can achieve high success, there are fundamental impediments to conventional transplantations. A lack of suitable donor corneas worldwide restricts the number of transplants that can be performed. Other barriers include the need for specialized expertise, high cost, and risks of graft rejection or failure. Research is underway to develop alternative treatments for corneal endothelial diseases, which are less dependent on the availability of allogeneic tissues – regenerative medicine and cell-based therapies. In this review, an overview of past and present transplantation procedures used to treat corneal endothelial diseases are described. Potential novel therapies that may be translated into clinical practice will also be presented.
- cornea
- corneal transplantation
- keratoplasty
- eye (tissue) banking
- cell therapy
- corneal endothelium
- regenerative medicine
- bullous keratopathy
- Fuchs’ endothelial dystrophy
- Ocular surface
- Inflammation
- Stem Cells
- Angiogenesis
- Infection
- Choroid
- Imaging
- Genetics
- Treatment Lasers
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Twitter Hon Shing Ong @onghonshing.
Contributors Conceptualisation and supervision: HSO, JM. Data curation/literature review: HSO. Formal nalysis and figures: HSO, JM. Writing draft, review and editing: HSO, MA, JM. All authors approved the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer This review contains some concepts that have been previously presented in a book format (Ong HS, Mehta JS. Corneal Endothelial Reconstruction: Current and Future Approaches in Agarwal A, Narang P. Video Atlas of Anterior Segment Repair and Reconstruction—Managing Challenges in Cornea, Glaucoma, and Lens Surgery. Stuttgart, New York, Rio: Thieme Publishing Group, 2019:41–52).
Competing interests JSM holds a patent on the EndoGlide and receive royalties. The other authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Provenance and peer review Not commissioned; externally peer reviewed.