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Emerging treatments for corneal endothelium decompensation — a systematic review

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Abstract

Purpose

Endothelial keratoplasty (EK) is the conventional treatment to improve visual acuity of corneal endothelium decompensation (CED) patients, with other therapies mainly for symptomatic relief. However, the shortage of corneal grafts and other limitations to EK urge the development of novel alternative treatments. In the last decade, novel options have been proposed, yet only a limited number of reviews have systematically reported on outcomes. Therefore, this systematic review evaluates the existing clinical evidence of novel surgical approaches for CED.

Method

We identified 24 studies that illustrated the clinical observations of the surgical approaches in interest. We included Descemet stripping only (DSO), Descemet membrane transplantation (DMT) where Descement membrane alone instead of corneal endothelium with cells is transplanted, and cell-based therapy.

Results

In general, these therapies may provide visual outcomes comparable with EK under specific conditions. DSO and DMT target CED with relatively healthy peripheral corneal endothelium like Fuchs’ corneal endothelial dystrophy, while cell-based therapy offers more versatile applications. Side effects of DSO would decrease with modifications to surgical techniques. Moreover, Rho-associated protein kinase inhibitor adjuvant therapy could enhance clinical results in DSO and cell-based therapy.

Conclusion

Long-term controlled clinical trials with larger sample size on the therapies are needed. The simplicity of DSO and the high translational potential of cell-based therapy to treat CED of most etiologies made these two treatment strategies promising.

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Funding

This work is supported by the Seed Funding for Basic Research, the University of Hong Kong.

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Authors and Affiliations

  1. Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Noel Cheong, Siu Wa Chui, Stephanie Hiu Ling Poon, Ho Lam Wong, Kendrick Co Shih & Yau Kei Chan

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  1. Noel Cheong
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  2. Siu Wa Chui
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  3. Stephanie Hiu Ling Poon
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  4. Ho Lam Wong
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  5. Kendrick Co Shih
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Contributions

N.C. and Y.K.C were involved in study design, data collection, data analysis, manuscript writing, and editing. S.W.C. was involved in data collection, data analysis, manuscript writing, and editing. S.H.L.P, H.L.W, and K.C.S. involved in data analysis, manuscript writing, and editing. All authors attest that they meet the current ICMJE criteria for authorship.

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Correspondence to Kendrick Co Shih or Yau Kei Chan.

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Cheong, N., Chui, S.W., Poon, S.H.L. et al. Emerging treatments for corneal endothelium decompensation — a systematic review. Graefes Arch Clin Exp Ophthalmol 262, 381–393 (2024). https://doi.org/10.1007/s00417-023-06129-7

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