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BLOG: Injections for corneal disease under study
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A few years ago, retina specialists dramatically changed their approach to the treatment of exudative maculopathy by using injections that suppress just the offending vessels instead of lasers that destroy adjacent tissue. Now we learn that injections may change the way we treat corneal disease as well.
Shigeru Kinoshita and other investigators recently described a method of replicating human endothelial cells in cell culture and combining them with Rho kinase inhibitors that permit their adhesion and viability as replacement cells for damaged endothelium. With 30 cases having results almost as good as the newest Descemet’s membrane endothelial keratoplasty procedure, it shows great promise for a minimally invasive endothelial keratoplasty of the future.
While the hope of a simpler endothelial replacement procedure is exciting, even more promising to me are studies investigating medical treatment of corneal stromal scars. How often do we encounter patients with scarring from past episodes of herpes simplex disease, previous bacterial infections, foreign bodies or other stroma-clouding diseases that leave patients with 20/40 or 20/50 vision? A stromal transplant (penetrating keratoplasty or deep anterior lamellar keratoplasty) hardly seems worthwhile in such cases. Gas permeable contact lens wear is often too frustrating to sustain. For these millions of patients, the ability to inject stromal keratocytes could be life changing. A study published in the journal Stem Cells in 2012 by James Funderburgh and associates describes the early work in this field.
Since the time I left training, treatment of endothelial disease has changed dramatically, with the advancing endothelial keratoplasty procedures now representing the majority of transplants performed in the U.S. Corneal stromal disease, on the other hand, has remained essentially unchanged since the turn of the century. Both our patients and we clinicians can be grateful to the researchers who offer us promise for advance in these life-changing conditions.
Reference:
Pinnamaneni N, et al. Stem Cells. 2012;doi:10.1002/stem.1100.