Corneal transplantation in the modern era

Abstract

Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.

Biofabrication of chitosan/chitosan nanoparticles/polycaprolactone transparent membrane for corneal endothelial tissue engineering

“…Human corneal endothelial cells (HCECs) do not proliferate in vivo and the cell loss to below the critical density caused by different condition such as aging, corneal disorders, and physical and chemical trauma lead to the visual impairments 3 . Full-thickness penetrating keratoplasty (PK), endothelial keratoplasty (EK), and two modern selective EK, Descemet's stripping automated endothelial keratoplasty (DESAK) and Descemet's membrane endothelial keratoplasty (DMEK) are generally used as the therapeutic choices for endothelium injuries 4 , 5 . However, these methods have faced many problems such as universal donor shortage and transplant failure due to post-surgical inflammation 6 .…”

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques

“…Indications for corneal transplantation are still different from one region to another, despite overall trends are indeed changing and converging: BK and FED have been seen to be most common indications for transplant in developed countries whereas infective keratitis and scars are more common in developing countries [ 11 , 15 – 17 ]. However, BK may represented the second indication—after FED [ 9 , 11 , 12 , 18 ] or keratoconus [ 19 , 20 ]—and even the third one [ 10 ].…”

A decellularized human corneal scaffold for anterior corneal surface reconstruction

“…Allogenic corneal transplantation is a highly successful technique to restore vision in patients with corneal diseases or after ocular trauma 1 . In eyes with moderate damage, the ocular immune privilege and the lack of corneal blood vessels decrease the risk for immunological transplant rejection.…”