Our Summary

The research paper is a review of recent advancements in alternative treatments for endothelial dysfunction, a condition that affects the inner lining of blood vessels. Keratoplasty, a corneal transplant surgery, is the current standard treatment, but it has limitations, including a lack of available donor tissue in many parts of the world.

New studies have shown that injecting cultivated allogeneic endothelial cells (cells from a donor of the same species) into the eye chamber and only stripping the Descemet’s membrane (a procedure known as ‘Descemet stripping only’) can be effective treatments. In addition, the use of a drug class known as Rho-associated kinase inhibitors (ROCKi) can improve these methods.

A new artificial implant, called EndoArt, has also shown promising results. Various drugs, especially ROCKi, have potential as standalone treatments, but none have been approved for use in humans yet.

Researchers are also exploring regenerative and genetic therapies, but these are still in the early stages of research.

The study concludes that while these new methods are promising, surgical approaches are still the most reliable treatment for endothelial disease. More research is needed to confirm whether these alternatives are better than keratoplasty. The drug, regenerative, and genetic therapies also need further testing before they can be used in clinics.

FAQs

  1. What are the main advancements in alternative strategies to keratoplasty during 2022-2023?
  2. What is the current status of pharmacologic, regenerative, and genetic therapies for endothelial disease?
  3. What is the role of Rho-associated kinase inhibitor (ROCKi) therapy in treating endothelial dysfunction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to follow the post-operative care instructions closely to ensure successful healing and recovery. This may include using prescribed eye drops, attending follow-up appointments, and avoiding activities that could strain the eye. It is also important to communicate any changes or concerns with the doctor promptly to address any issues that may arise.

Suitable For

Patients who are typically recommended for corneal transplant are those with endothelial dysfunction, which can include conditions such as Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy. These patients may experience symptoms such as decreased vision, glare, and difficulty with night driving due to corneal edema and clouding.

In cases where traditional corneal transplant with donor tissue is not readily available or feasible, alternative strategies such as intracameral cultivated allogeneic endothelial cell injection, Descemet stripping only, and artificial implants like EndoArt may be considered. These newer techniques show promising results and may offer benefits such as improved visual outcomes and reduced risk of rejection compared to traditional corneal transplant.

Additionally, pharmacologic agents like Rho-associated kinase inhibitors (ROCKi) are being investigated as potential monotherapies for endothelial dysfunction. While these treatments show promise, they are not yet approved for human use and further research is needed to establish their efficacy and safety.

Overall, patients recommended for corneal transplant are those with significant endothelial dysfunction that is impacting their quality of life and visual function. It is important for patients to discuss their options with their ophthalmologist to determine the best treatment approach for their individual needs.

Timeline

Before corneal transplant:

  1. Patient experiences symptoms of endothelial dysfunction, such as blurry vision, glare, and light sensitivity.
  2. Patient undergoes a comprehensive eye exam to determine the extent of the corneal damage.
  3. Patient is informed about the need for a corneal transplant and the potential risks and benefits of the surgery.
  4. Patient is placed on a waiting list for a donor cornea, which can take months to years to obtain.
  5. Patient may undergo preoperative tests and evaluations to ensure they are a suitable candidate for surgery.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, which can be either a full-thickness transplant or a partial-thickness transplant, depending on the extent of the damage.
  2. Patient may experience some discomfort and blurred vision in the days following surgery as the eye heals.
  3. Patient is prescribed eye drops to prevent infection and promote healing.
  4. Patient attends follow-up appointments with their ophthalmologist to monitor the progress of the transplant and ensure proper healing.
  5. Patient may need to use prescription eye drops for several months to years to prevent rejection of the donor cornea.
  6. Patient gradually experiences improved vision and relief from symptoms of endothelial dysfunction as the donor cornea integrates successfully into the eye.

What to Ask Your Doctor

  1. What is the success rate of corneal transplants compared to alternative treatments such as intracameral cultivated allogeneic endothelial cell injection and Descemet stripping only?

  2. How does adjunctive Rho-associated kinase inhibitor (ROCKi) therapy improve outcomes for corneal transplant patients?

  3. What are the risks and benefits of using donor-independent artificial implants like EndoArt compared to traditional donor tissue?

  4. Are there any pharmacologic agents, including ROCKi, that can be used as monotherapies for treating endothelial dysfunction without the need for a transplant?

  5. What is the current status of regenerative and genetic therapies for corneal transplant patients, and when can they be expected to be available for clinical use?

  6. How do these alternative treatments compare in terms of cost, recovery time, and long-term outcomes compared to traditional corneal transplants?

  7. Are there any clinical trials or research studies available that I may be eligible to participate in for these alternative treatments?

  8. How can I best prepare for and optimize the success of a corneal transplant procedure, regardless of the specific treatment method chosen?

  9. What are the potential complications or side effects associated with these alternative treatments, and how are they managed?

  10. How will the choice between traditional keratoplasty and alternative treatments impact my quality of life and visual outcomes in the long term?

Reference

Authors: Kaufman R, Jun AS. Journal: Curr Opin Ophthalmol. 2024 Sep 1;35(5):415-422. doi: 10.1097/ICU.0000000000001071. Epub 2024 Jun 26. PMID: 38941153