Emerging Technologies to Solve the Key Issues in Endothelial Keratoplasty
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OPHTHALMOLOGY (D MYUNG, SECTION EDITOR)
Emerging Technologies to Solve the Key Issues in Endothelial Keratoplasty Karl David Brown 1 & Gregory J. Dusting 1,2 & Mark Daniell 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Endothelial keratoplasty (EK) is increasingly used to treat corneal endothelial disease. However, issues remain with EK including a non-zero rejection rate, shortage of donor tissue, and technical challenges for Descemet’s membrane endothelial keratoplasty. Technologies that might solve these issues include small-molecule drugs, surgical innovations, cell therapy, tissue engineering, and gene therapy. Our purpose is to inform ophthalmologists, eye bankers, and eye health professionals of technologies that could impact practice in the near future. Recent Findings Recent advances are targeted at solving known issues with EK. Although none is yet routine, some are in clinical trials. Technologies that are closest to an ideal solution are those facing the highest regulatory and commercial hurdles. Summary In the future, there will multiple options for the treatment of corneal endothelial cell failure. Which of these differing treatments will be used will depend on their efficacy as well as commercial, regulatory, and patient factors. Keywords Corneal endothelium, endothelial keratoplasty . Pharmacological therapy . Cell therapy . Tissue engineering . Gene therapy
Introduction Penetrating keratoplasty remains the dominant corneal transplant technique globally [1]. However, lamellar techniques have rapidly evolved over the past decade. Endothelial keratoplasty now accounts for more than 30% of corneal transplants [1] due to the reduced surgical risk and the improved patient outcomes. Endothelial keratoplasty treats the most common causes of corneal opacity: endothelial cell disease; This article is part of the Topical Collection on Regenerative Medicine in Ophthalmology * Karl David Brown [email protected] Gregory J. Dusting [email protected] Mark Daniell [email protected] 1
Centre for Eye Research Australia, level 7, Peter Howson Wing, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia
2
Ophthalmology, Department of Surgery, University of Melbourne and Royal Victorian Eye and Ear Hospital, East Melbourne 3002, Australia
39% of corneal transplants globally are for Fuchs’ endothelial dystrophy [1] whilst pseudophakic bullous keratopathy is a major indication for older patients, particularly in India and China [2]. There are two widely used endothelial keratoplasties, Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). In DSAEK, the endothelium is supported by a thin layer of donor stroma. In DMEK, only the Descemet’s membrane with corneal endothelial cells is transplanted. The main limitation on any keratoplasty is the supply of tissue [1, 2]. For every 70 corneas required worldwide, only one is available and more than 50% of the world’s population has n
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