New Horizons in the Treatment of Corneal Endothelial Dysfunction.

Carlos Rocha-De-Lossada,Eitan Livny,José-María Sánchez-González,Marina Rodríguez Calvo-De-Mora,Rahul Rachwani-Anil,Fernando-Luis Soler-Ferrández,Vito Romano,Jose-Antonio Gegúndez-Fernández,Davide Borroni,Raquel Esteves-Marques,Carlo Cagini

doi:10.1155/2021/6644114

Abstract

The treatment of corneal endothelial dysfunction has experienced a revolutionary change in the past decades with the emergence of endothelial keratoplasty techniques: descemet stripping automated endothelial keratoplasty (DSAEK) and descemet membrane endothelial keratoplasty (DMEK). Recently, new treatments such as cultivated endothelial cell therapy, Rho-kinase inhibitors (ROCK inhibitors), bioengineered grafts, and gene therapy have been described. These techniques represent new lines of treatment for endothelial dysfunction. Their advantages are to help address the shortage of quality endothelial tissue, decrease the complications associated with tissue rejection, and reduce the burden of postoperative care following transplantation. Although further randomized clinical trials are required to validate these findings and prove the long-term efficacy of the treatments, the positive outcomes in preliminary clinical studies are a stepping stone to a promising future. Our aim is to review the latest available alternatives and advancements to endothelial corneal transplant.

Highlights

It is supposed that corneal endothelial cells (CEC) have a limited regenerative capacity in vivo as they remain inactive in the G1 phase of the cellular cycle [1]
When there is a loss of CEC, the damage triggers a countervailing migration and an increase in the size of the adjacent healthy CEC, resulting in a global decrease in endothelial cell density (ECD) in order to restore the single layer of CEC [1]
This technique has reported to have a longer learning curve than descemet stripping automated endothelial keratoplasty (DSAEK), and a higher rate of postoperative graft detachment which is usually balanced after the learning curve [10,11,12,13]. e use of thinner grafts in DSAEK (

Summary

Introduction

BCVA remained stable after three years in hemi-DMEK and after two years in quarter-DMEK procedures [23,24,25] Both techniques, especially quarterDMEK, could be reserved for cases of central FED and patients with different anterior chamber (AC) abnormalities, such as peripheral anterior synechiae or the presence of glaucoma valve implants. Especially quarterDMEK, could be reserved for cases of central FED and patients with different anterior chamber (AC) abnormalities, such as peripheral anterior synechiae or the presence of glaucoma valve implants Another technique termed descemet membrane endothelial transfer (DMET) was developed after observing corneal clearance despite subtotal graft detachment in patients operated for DSAEK or DMEK [26, 27]. The cell regenerative capacity of FED patients might not be enough to guarantee permanent corneal transparency, as corneal decompensation six months after DMET has been reported [29]

Alternatives to Tissue Grafting

ROCK Inhibitors

Gene Therapy

Mechanic Artificial Endothelium

Findings

Conclusion