New Hope for the Treatment of Corneal Endothelial Disease
The cutting edge in corneal regenerative medicine
The corneal endothelium is a population of cells required for the maintenance of corneal clarity. These cells lose all ability to regenerate after age 7 and therefore any disease process adversely affecting this cellular layer will create serious visual consequences. Conditions such as Fuchs Dystrophy or Pseudo-phakic Bullous Keratopathy can lead to the need of corneal transplant surgery, either full thickness or lamellar in nature.
Shigeru Kinoshita, MD, Kyoto, Japan and colleagues continue to investigate what they believe could be a future option for corneal endothelial therapy.
They proposed the use of injections of cultivated corneal endothelial cells (CECs) for the treatment of advanced endothelial dysfunction and Rho kinase (ROCK) inhibitor Y-27632 eye drops for early stages.
Whereas older donor corneas are used for keratoplasty procedures, Dr. Kinoshita believes that young donors could be used to cultivate CECs. Moreover, one donor can potentially be used for over 100 patients. The protocol they use for cultivating CECs involves the use of ROCK inhibitor to promote proliferation. Epithelial-mesenchymal transformation (EMT) is limited by the use of mesenchymal stem cell condition media (MSC-CM).
To date, they have injected cultivated CECs into 9 patients, including cases of bullous keratopathy and Fuchs’ dystrophy. Meanwhile, Dr. Kinoshita and his colleagues have also investigated the use of ROCK inhibitor eye drops to treat 8 cases with less advanced endothelial disease to promote cellular regeneration. One case of an 84 year old female with accidental Descemet’s membrane removal after cataract surgery who began with counting fingers vision progressed to a visual acuity of 20/25 at 11 weeks with treatment with ROCK inhibitor eye drops. At 1 month, the cells could be seen attached to the posterior surface of the cornea even without the Descemet’s membrane and by 6 months the cells resembled CECs.