Abstract
Human corneal endothelial cells (HCECs) do not replicate after wounding. Therefore, corneal endothelial deficiency can result in irreversible corneal edema. Descemet stripping automated endothelial keratoplasty (DSAEK) allows selective replacement of the diseased corneal endothelium. However, DSAEK requires a donor cornea and the worldwide shortage of corneas limits its application. This review presents current knowledge on the tissue engineering of corneal endothelium using cultured HCECs. We also provide our recent work on tissue engineering for DSAEK grafts using cultured HCECs. We reconstructed DSAEK grafts by seeding cultured DiI-labelled HCECs on collagen sheets. Then HCEC sheets were transplanted onto the posterior stroma after descemetorhexis in the DSAEK group. Severe stromal edema was detected in the control group, but not in the DSAEK group throughout the observation period. Fluorescein microscopy one month after surgery showed numerous DiI-labelled cells on the posterior corneal surface in the DSAEK group. Frozen sections showed a monolayer of DiI-labelled cells on Descemet’s membrane. These findings indicate that cultured adult HCECs, transplanted with DSAEK surgery, maintain corneal transparency after transplantation and suggest the feasibility of performing DSAEK with HCECs to treat endothelial dysfunction.
Highlights
The cornea is composed of a multilayered epithelium, Bowman’s membrane, stroma, Descemet’s membrane, and endothelium (Figure 1)
They concluded that Human Corneal endothelial cells (CECs) (HCECs) cultured in MEM media seem susceptible to cell death in the absence of exogenous noxious stimuli, while HCEC cultured in serum-free medium (SFM) seem to be protected from cell death even when the apoptosis-inducer staurosporine is added [53]
These results suggest the feasibility of performing corneal reconstruction by using HCECs cultured from adult donor corneas
Summary
The cornea is composed of a multilayered epithelium, Bowman’s membrane, stroma, Descemet’s membrane, and endothelium (Figure 1). Descemet stripping with automated endothelial keratoplasty (DSAEK) has recently become a standard procedure for corneal transplantation in patients with endothelial dysfunction [13,14,15,16]. This procedure improves postoperative visual function and reduces the risks associated with PKP, such as severe astigmatism and expulsive hemorrhage. Human donor corneas were handled according to the tenets of the Declaration of Helsinki of 1975 and its 1983 revision
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