Abstract:Endothelial keratoplasty has been adopted by corneal surgeons worldwide as an alternative to penetrating keratoplasty (PK) in the treatment of corneal endothelial disorders. Since the first surgeries in 1998, different surgical techniques have been used to replace the diseased endothelium. Compared with penetrating keratoplasty, all these techniques may provide faster and better visual rehabilitation with minimal change in refractive power of the transplanted cornea, minimal induced astigmatism, elimination of… Show more
“…Although the rabbit corneal endothelium and the human corneal endothelium are significantly different with respect to cell proliferation, our study is clinically relevant. Endothelial transplantation surgeries, such as Descemet’s membrane endothelial keratoplasty (DMEK), Descemet’s stripping endothelial keratoplasty (DSEK), and Descemet’s stripping automated endothelial keratoplasty (DSAEK), are frequently performed in the treatment of corneal endothelial diseases 40 , and the DM was normally stripped away, with a damaged endothelium, in these surgeries 41 . Long-term follow-up showed a high incidence of posterior stromal and graft interface haze 42 , 43 .…”
Descemet’s membrane (DM) helps maintain phenotype and function of corneal endothelial cells under physiological conditions, while little is known about the function of DM in corneal endothelial wound healing process. In the current study, we performed in vivo rabbit corneal endothelial cell (CEC) injury via CEC scraping, in which DM remained intact after CECs removal, or via DM stripping, in which DM was removed together with CECs. We found rabbit corneas in the CEC scraping group healed with transparency restoration, while there was posterior fibrosis tissue formation in the corneas after DM stripping on day 14. Following CEC scraping on day 3, cells that had migrated toward the central cornea underwent a transient fibrotic endothelial-mesenchymal transition (EMT) which was reversed back to an endothelial phenotype on day 14. However, in the corneas injured via DM stripping, most of the cells in the posterior fibrosis tissue did not originate from the corneal endothelium, and they maintained fibroblastic phenotype on day 14. We concluded that corneal endothelial wound healing in rabbits has different outcomes depending upon the presence or absence of Descemet’s membrane. Descemet’s membrane supports corneal endothelial cell regeneration in rabbits after endothelial injury.
“…Although the rabbit corneal endothelium and the human corneal endothelium are significantly different with respect to cell proliferation, our study is clinically relevant. Endothelial transplantation surgeries, such as Descemet’s membrane endothelial keratoplasty (DMEK), Descemet’s stripping endothelial keratoplasty (DSEK), and Descemet’s stripping automated endothelial keratoplasty (DSAEK), are frequently performed in the treatment of corneal endothelial diseases 40 , and the DM was normally stripped away, with a damaged endothelium, in these surgeries 41 . Long-term follow-up showed a high incidence of posterior stromal and graft interface haze 42 , 43 .…”
Descemet’s membrane (DM) helps maintain phenotype and function of corneal endothelial cells under physiological conditions, while little is known about the function of DM in corneal endothelial wound healing process. In the current study, we performed in vivo rabbit corneal endothelial cell (CEC) injury via CEC scraping, in which DM remained intact after CECs removal, or via DM stripping, in which DM was removed together with CECs. We found rabbit corneas in the CEC scraping group healed with transparency restoration, while there was posterior fibrosis tissue formation in the corneas after DM stripping on day 14. Following CEC scraping on day 3, cells that had migrated toward the central cornea underwent a transient fibrotic endothelial-mesenchymal transition (EMT) which was reversed back to an endothelial phenotype on day 14. However, in the corneas injured via DM stripping, most of the cells in the posterior fibrosis tissue did not originate from the corneal endothelium, and they maintained fibroblastic phenotype on day 14. We concluded that corneal endothelial wound healing in rabbits has different outcomes depending upon the presence or absence of Descemet’s membrane. Descemet’s membrane supports corneal endothelial cell regeneration in rabbits after endothelial injury.
“…Finally, endothelial keratoplasties (EKs) account for approximately 54% of the procedures performed annually [2], exploited by surgeons worldwide as an alternative to PKs for the treatment of endothelial corneal disorders [30]. An EK involves the selective removal and replacement of the corneal endothelium [31] when only the endothelium is damaged.…”
Section: Keratoplastymentioning
confidence: 99%
“…Compared to a PK, the major benefit is the possibility of maintaining the structural integrity of the eye, thereby reducing the risk of rejection. Other advantages include a more effective and faster visual rehabilitation, minimization of induced astigmatism, and the elimination of some complications due to the final sutures [30,32,33]. This is evidenced by the decreasing annual number of PK procedures over the years in the United States, from 42,063 in 2005 to 19,294 in 2014.…”
The inner structures of the eye are protected by the cornea, which is a transparent membrane exposed to the external environment and subjected to the risk of lesions and diseases, sometimes resulting in impaired vision and blindness. Several eye pathologies can be treated with a keratoplasty, a surgical procedure aimed at replacing the cornea with tissues from human donors. Even though the success rate is high (up to 90% for the first graft in low-risk patients at 5-year follow-up), this approach is limited by the insufficient number of donors and several clinically relevant drawbacks. Alternatively, keratoprosthesis can be applied in an attempt to restore minimal functions of the cornea: For this reason, it is used only for high-risk patients. Recently, many biomaterials of both natural and synthetic origin have been developed as corneal substitutes to restore and replace diseased or injured corneas in low-risk patients. After illustrating the traditional clinical approaches, the present paper aims to review the most innovative solutions that have been recently proposed to regenerate the cornea, avoiding the use of donor tissues. Finally, innovative approaches to biological tissue 3D printing and xenotransplantation will be mentioned.
“…Posterior lamellar keratoplasty has emerged as an alternative to PK to treat corneal endothelial pathology [63,64]. Evolution of the posterior lamellar keratoplasty procedures began with Melles et al, who reported deep lamellar endothelial keratoplasty (DLEK) that includes sutureless transplantation of posterior lamellae of cornea from a scleral incision [65].…”
Section: Oct In Posterior Lamellar Keratoplastymentioning
Anterior segment optical coherence tomography (AS-OCT) is a valuable tool in corneal transplantation surgery. In deep anterior lamellar keratoplasty (DALK), AS-OCT gives valuable information on preoperative decision process. AS-OCT image of the recipient cornea helps the surgeon to decide whether to proceed with a big bubble DALK or a manual dissection. Preoperative AS-OCT imaging of recipient stroma can also predict Descemet membrane perforation during big bubble induction. Intraoperative AS-OCT assures reaching the proper depth in order, and postoperatively, a surgeon can objectively assess the Descemet membrane and donor association and define complications such as a double anterior chamber. Before deciding for a Descemet membrane endothelial keratoplasty (DMEK), preoperative stromal scars can be identified with an AS-OCT and might affect the decision of the surgical procedure (DMEK or penetrating keratoplasty).
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