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Parker J, Dockery P, Preda-Naumescu A, Jager M, van Dijk K, Dapena I, Melles G. Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey. Ophthalmic Res 2021; 64:532-553. [PMID: 33761502 DOI: 10.1159/000516093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation - inlay and more recently onlay techniques - has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a "postkeratoplasty" world.
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Affiliation(s)
- Jack Parker
- Parker Cornea, Birmingham, Alabama, USA.,Netherlands Institute for Innovative Ocular Surgery- USA (NIIOS-USA), San Diego, California, USA
| | - Philip Dockery
- Parker Cornea, Birmingham, Alabama, USA.,Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Ana Preda-Naumescu
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Martine Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit Melles
- Parker Cornea, Birmingham, Alabama, USA.,Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands.,Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
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Yuan AE, Pineda R. Regenerative medicine in Fuchs' endothelial corneal dystrophy. Taiwan J Ophthalmol 2020; 11:122-131. [PMID: 34295617 PMCID: PMC8259529 DOI: 10.4103/tjo.tjo_23_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/09/2022] Open
Abstract
The management of Fuchs' endothelial corneal dystrophy (FECD) has evolved rapidly since the introduction of endothelial keratoplasty (EK). In recent years, advances in our understanding of endothelial cell biology, in particular with respect to the regenerative capacity of endothelial cells, have opened the door to novel therapeutic options that stray from the traditional paradigm of allograft transplantation. We review the development of descemetorhexis without EK (DWEK) as a primary treatment for FECD and discuss the lessons learned to date about the mechanism of wound healing, surgical technique, patient selection, and refractive outcomes. Multiple randomized clinical trials are currently underway to evaluate the potential for pharmacological supplementation with rho-associated kinase inhibitors to increase the success rate of corneal clearance following DWEK. Biologic supplementation with intracameral endothelial cell injection and acellular Descemet's membrane transplantation are other avenues of adjuvant therapy. DWEK is a promising surgical option for management of a subset of FECD patients.
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Affiliation(s)
- Amy E Yuan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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The future of keratoplasty: cell-based therapy, regenerative medicine, bioengineering keratoplasty, gene therapy. Curr Opin Ophthalmol 2019; 30:286-291. [PMID: 31045881 DOI: 10.1097/icu.0000000000000573] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To provide an update on the state of development of novel therapeutic modalities for the treatment of corneal diseases. RECENT FINDINGS Novel corneal therapeutics may be broadly classified as cell therapy, regenerative medicine, bioengineered corneal grafts and gene therapy. Cell therapy encompasses cultivation of cells, such as corneal endothelial cells (CECs) and keratocytes to replenish the depleted native cell population. Regenerative medicine is mainly applicable to the corneal endothelium, and is dependent on the ability of native, healthy CECs to restore the corneal endothelium following trauma or descemetorhexis; this approach may be effective for the treatment of Peter's anomaly and Fuchs endothelial corneal dystrophy (FECD). Bioengineered corneal grafts are synthetic constructs designed to replace cadaveric corneal grafts; tissue-engineered endothelial-keratoplasty grafts and bioengineered stromal grafts have been experimented in animal models with favourable results. Gene therapy with antisense oligonucleotide and CRISPR endonucleases, including deactivated Cas9, may potentially be used to treat FECD and TGFBI-related corneal dystrophies. SUMMARY These novel therapeutic modalities may potentially supersede keratoplasty as the standard of care in the future.
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