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Publication Exclusive: Advances in regenerative medicine may alter treatment of corneal endothelial diseases
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The last decade has seen significant advances in the field of corneal surgery. Various lamellar keratoplasty techniques have been refined, and endothelial keratoplasty in the form of Descemet’s stripping automated endothelial keratoplasty has now become the standard for endothelial diseases. Worldwide, DSAEK is now one of the most common techniques for endothelial transplant, with excellent functional outcomes.
However, Descemet’s membrane endothelial keratoplasty, with its better functional results and faster visual recovery, is now challenging DSAEK. The concern with DMEK is the handling of the delicate Descemet’s membrane and endothelium and the surgical trauma to the endothelium that occurs during the insertion of the scrolled tissue into the anterior chamber. The technique to unscroll the Descemet’s membrane endothelial complex, the prolonged time to unfold, as well as issues with identifying the correct orientation are challenges facing the novice surgeon. Various techniques to assist the insertion and reduce the surgical time and trauma to the endothelium, such as Busin’s technique of tri-folding the donor endothelium complex on a scaffold of soft contact lens to transfer the tissue using a bimanual injector system or that by Tan using a Descemet’s mat or corneal tissues along with the endo inserter, are interesting concepts.
Simultaneously, the last few years have also focused on stimulating the migration of healthy peripheral corneal endothelial cells to the center to achieve corneal clarity.
Click here to read the full commentary from Bhaskar Srinivasan, MD, and Dennis S.C. Lam, MD, FRCOphth, published in Ocular Surgery News APAO Edition, April 2016.