Evolving Techniques in Corneal Transplantation

Boynton, Grace E.; Woodward, Maria A.

doi:10.1007/s40137-014-0079-5

Cited by 33 publications

(27 citation statements)

References 65 publications

(74 reference statements)

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“…Accelerated degeneration of the corneal endothelium remains a substantial risk for any of the annual worldwide 185,000 corneal transplants,38 although cornea transplantation remains the only successful option to partially restore the cornea endothelium. Transplant procedures involve either the replacement of all cornea layers or just the CEC layer and the adjacent basement membrane 9. These partial transplants use donor CECs in Descemet's membrane endothelial keratoplasty and Descemet's stripping automated endothelial keratoplasty (DSAEK) grafts to replace lost and damaged CECs 32.…”

Section: Discussionmentioning

confidence: 99%

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Myh11 Lineage Corneal Endothelial Cells and ASCs Populate Corneal Endothelium

Corliss

Ray

Mathews

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To establish Myh11 as a marker of a subset of corneal endothelial cells (CECs), and to demonstrate the feasibility of restoring the corneal endothelium with Myh11-lineage (Myh11-Lin[þ]) adipose-derived stromal cells (ASCs). METHODS. Intraperitoneal administration of tamoxifen and (Z)-4-hydroxytamoxifen eyedrops were used to trace the lineage of Myh11-expressing cells with the Myh11-Cre-ER T2-flox-tdTomato mouse model. Immunostaining and Western blot characterized marker expression and spatial distribution of Myh11-Lin(þ) cells in the cornea, and administration of 5-ethynyl-2 0-deoxyuridine labeled proliferating cells. ASCs were isolated from epididymal adipose Myh11þ mural cells and treated with cornea differentiation media to evaluate corneal endothelial differentiation potential. Differentiated ASCs were injected into the anterior chamber to test for incorporation into corneal endothelium following scratch injury. RESULTS. A subset of CECs express Myh11, a marker previously thought restricted to only mural cells. Myh11-Lin(þ) CECs marked a stable subpopulation of cells in the cornea endothelium. Myh11-Lin(þ) ASCs undergo CEC differentiation in vitro and incorporate into injured corneal endothelium. CONCLUSIONS. Dystrophy and dysfunction of the corneal endothelium accounts for almost half of all corneal transplants, the maintenance of the cornea endothelium is poorly understood, and there are a lack of mouse models to study specific CEC populations. We establish a mouse model that can trace the cell fate of a subpopulation of CECs based on Myh11 expression. A subset of ASCs that share this Myh11 transcriptional lineage are capable of differentiating into CECs that can incorporate into injured corneal endothelium, revealing a potential cell source for creating engineered transplant material.

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Section: Discussionmentioning

confidence: 99%

“…Disruption of this cell population can occur with various corneal diseases,7 hypoxia caused by long-term wear of contacts,8 and cornea transplant surgery 9. Paradoxically, corneal transplants are often the only therapeutic option for a depleted corneal endothelium, but the trauma from the surgical procedure can lead to further dropout of CECs 10.…”

mentioning

confidence: 99%

Myh11 Lineage Corneal Endothelial Cells and ASCs Populate Corneal Endothelium

Corliss

Ray

Mathews

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…Overall, physicians will have to pay attention to assessing and improving image quality in post transplant eyes in order to provide full benefit of binocular vision to the patient. The steps in this could include improved surgical technique to ensure superior corneal topography, postoperative modifications or use of corneal topography correcting contact lenses [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…This procedure–penetrating keratoplasty–remains the gold-standard treatment even as newer surgical procedures are evolving to transplant only parts of diseased cornea for vision restoration (e.g. Descemet’s Stripping Endothelial Keratoplasty [DSEK] for corneal endothelial disease[ 4 ]).…”

Section: Introductionmentioning

confidence: 99%

Corneal Transplantation in Disease Affecting Only One Eye: Does It Make a Difference to Habitual Binocular Viewing?

2016

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BackgroundClarity of the transplanted tissue and restoration of visual acuity are the two primary metrics for evaluating the success of corneal transplantation. Participation of the transplanted eye in habitual binocular viewing is seldom evaluated post-operatively. In unilateral corneal disease, the transplanted eye may remain functionally inactive during binocular viewing due to its suboptimal visual acuity and poor image quality, vis-à-vis the healthy fellow eye.Methods and FindingsThis study prospectively quantified the contribution of the transplanted eye towards habitual binocular viewing in 25 cases with unilateral transplants [40yrs (IQR: 32–42yrs) and 25 age-matched controls [30yrs (25–37yrs)]. Binocular functions including visual field extent, high-contrast logMAR acuity, suppression threshold and stereoacuity were assessed using standard psychophysical paradigms. Optical quality of all eyes was determined from wavefront aberrometry measurements.Binocular visual field expanded by a median 21% (IQR: 18–29%) compared to the monocular field of cases and controls (p = 0.63). Binocular logMAR acuity [0.0 (0.0–0.0)] almost always followed the fellow eye’s acuity [0.00 (0.00 –-0.02)] (r = 0.82), independent of the transplanted eye’s acuity [0.34 (0.2–0.5)] (r = 0.04). Suppression threshold and stereoacuity were poorer in cases [30.1% (13.5–44.3%); 620.8arc sec (370.3–988.2arc sec)] than in controls [79% (63.5–100%); 16.3arc sec (10.6–25.5arc sec)] (p<0.001). Higher-order wavefront aberrations of the transplanted eye [0.34μ (0.21–0.51μ)] were higher than the fellow eye [0.07μ (0.05–0.11μ)] (p<0.001) and their reduction with RGP contact lenses [0.09μ (0.08–0.12μ)] significantly improved the suppression threshold [65% (50–72%)] and stereoacuity [56.6arc sec (47.7–181.6arc sec)] (p<0.001).ConclusionsIn unilateral corneal disease, the transplanted eye does participate in gross binocular viewing but offers limited support to fine levels of binocularity. Improvement in the transplanted eye’s optics enhances its participation in binocular viewing. Current metrics of this treatment success can expand to include measures of binocularity to assess the functional benefit of the transplantation process in unilateral corneal disease.

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“…30 Corneal epithelial cell loss can cause permanent vision impairment and often requires corneal grafting. Corneas are the most frequently transplanted tissue worldwide (>68,000 tissues supplied for keratoplasty in 2012 in the United States) 31 and as a result of its immune-privileged status, the procedure is very successful.…”

Section: Discussionmentioning

confidence: 99%