Abstract
BackgroundTo report on corneal endothelial regeneration, graft clarity, and vision recovery when using endothelium-free grafts.MethodsWe evaluated the donor’s cell viability using trypan blue staining and dual staining with calcein acetoxy methyl ester and ethidium homodimer-1. To preserve eyeball integrity, we performed therapeutic penetrating keratoplasty using cryopreserved donor tissue without endothelium on 195 consecutive patients who suffered from corneal perforation due to progressive primary corneal disease such as herpes simplex keratitis, fungal keratitis, ocular thermal burns, keratoconus, and phlyctenular keratoconjunctivitis. Of these, 18 eyes recovered corneal graft clarity and underwent periodic slit-lamp microscopy, A-scan pachymetry, and in vivo confocal microscopy to observe the clinical manifestations, variations in corneal thickness, and repopulation of the corneal endothelial cells on the donor grafts.ResultsNo viable cells were detected in the cryopreserved corneas. After the therapeutic penetrating keratoplasty, notable corneal graft edema was observed in all 18 eyes for 1–4 months, and no corneal endothelial cells were detected on the grafts during this period. Thereafter, we observed gradual and progressive regression and final resolution of the stromal edema, with complete recovery of corneal graft clarity. Through periodic confocal microscopy, we observed the corneal endothelium’s regenerating process, along with single cells bearing multiple nuclei and cell division-like morphology. The regenerated endothelium on the grafts reached a mean cell density of 991 cells/mm2. Remarkable vision rehabilitation was achieved in all 18 patients.ConclusionsWe obtained conclusive evidence that host-derived endothelial cells can regenerate a new endothelium over the endothelium-free graft, which possesses normal functions for corneal clarity and vision recovery.
Highlights
To report on corneal endothelial regeneration, graft clarity, and vision recovery when using endothe‐ lium-free grafts
We have previously reported the effectiveness of therapeutic penetrating keratoplasty (PKP) using cryopreserved donor corneal tissue for eradicating infection and preserving the eyeball integrity of eyes with severe fungal infection [28]
The graft edema subsequently subsided significantly, along with marked corneal thinning compared with previous manifestations, and the corneal clarity improved significantly, retaining a certain degree of mild to moderate edema (Figs. 1B and 2B)
Summary
To report on corneal endothelial regeneration, graft clarity, and vision recovery when using endothe‐ lium-free grafts. Ying et al BMC Ophthalmology (2022) 22:32 endothelial barrier and pump functions is compromised, and corneal endothelial decompensation occurs, manifesting as epithelial bullae, stromal edema, corneal clouding, and severe vision impairment, which can only be reversed by the transplantation of donor cornea with a healthy endothelium [1, 16, 17]. Human corneal endothelial cells lack regenerative capacity in vivo [18,19,20]. Ex vivo experiments have suggested that the periphery of the corneal endothelium has a higher regenerative capacity in vitro than the center [17, 23]. This study provides clear evidence that a new functional endothelium can be regenerated on endothelium-free corneal grafts in human eyes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
