Implantation of an Artificial Endothelial Layer for Treatment of Chronic Corneal Edema

Abstract

The purpose of this study was to describe a novel device that may serve as an alternative to Descemet membrane endothelial keratoplasty (DMEK) for the treatment of chronic corneal edema. Methods:The EndoArt (EyeYon Medical, Israel) is a flexible, 50mm thin artificial endothelial layer that matches the cornea's posterior curvature and functions as a fluid barrier at the posterior stroma, replacing the diseased endothelium. Similar to a DMEK approach, it is implanted into the anterior chamber, carefully positioned on the posterior stroma, and secured using an air-gas mixture. Two patients with chronic corneal edema resulting from endothelial decompensation underwent implantation of the new artificial lamella. Results:In patient 1, the central corneal thickness (CCT) decreased from 730 mm preoperatively to 593 mm at 1 day postoperatively. In patient 2, the CCT decreased from 761 mm preoperatively to 487 mm at 1 day postoperatively. Both patients reported high satisfaction and an overall brighter visual quality. Although dislocation of the lamella occurred in both cases, the CCT was promptly restored after a repositioning procedure and remained stable at the 17-month followup (CCT of 526 and 457 mm for patients 1 and 2, respectively). In contrast to DMEK donor tissue, the artificial lamella is sufficiently robust to allow easy intraocular manipulation without the risk of damaging the implant. It is easily removable and does not require any immunosuppressive treatment because of its nonbiological nature.Conclusions: Implantation of the EndoArt led to rapid corneal deturgescence and CCT restoration, presenting a possible option for patients with chronic corneal edema.

Management of endothelial disease without keratoplasty

“…One patient had endothelial decompensation from multiple intraocular surgeries and the other had primary DMEK graft failure after initial surgery for corneal edema from FECD. Both cases achieved rapid corneal deturgescence and remained clear 17 months after surgery [28 ▪▪ ].…”

“…Unlike the natural endothelium, it does not function as a pump. Corneal edema is reduced through epithelial evaporation in the setting of decreased aqueous influx into the stroma [28 ▪▪ ]. The implantation technique is analogous to DMEK.…”

Early Visibility of Cellular Aggregates and Changes in Central Corneal Thickness as Predictors of Successful Corneal Endothelial Cell Injection Therapy

“…Alternative solutions that overcome the constraints of donor shortage are required, and numerous options are being investigated. These include regenerative medicine approaches, such as Descemet Stripping Only (DSO) [ 48 ], synthetic approaches such as the EndoArt (EyeYon Medical, Ness Ziona, Israel), an artificial endothelial layer [ 49 ], and a plethora of bioengineering approaches that have been comprehensively reviewed elsewhere [ 44 , 50 , 51 , 52 ]. CECI is one such promising solution in a growing field, but questions remain regarding its long-term efficacy and safety.…”

Current Advancements in Corneal Cell–Based Therapy

“…One is the novel development of artificially constructed corneas using cutting-edge materials (eg, medical-grade polymethyl methacrylate), of which some are currently used in the clinical setting, such as the Boston keratoprosthesis (types 1 and 2) and KPro (Massachusetts Eye and Ear Infirmary, Boston, MA), 1,2 an osteo-odonto keratoprosthesis surgery, 3 and even more recently, artificial corneas developed via bioprinting technologies. 4 An artificial corneal stroma for the treatment of keratoconus and corneal scarring, 5 as well as an artificial posterior corneal surface layer, have also been experimentally applied in a few cases as substitutes for seriously damaged corneal stroma or endothelium, 6 although debate remains as to the clinical relevance.…”