Regeneration of the Corneal Endothelium

ABSTRACT

Penetrating keratoplasty was the only therapeutic choice for the treatment of corneal endothelial decompensation until the introduction of evolutional endothelial keratoplasties, namely Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Although now in widespread use, DSAEK and DMEK still have associated problems, such as difficulty of the surgical technique, acute and chronic cell loss, and shortage of donor corneas. Therefore, regeneration of the corneal endothelium by tissue engineering techniques is being researched to overcome these problems. The concept of transplantation of cultured corneal endothelial cells (CECs) was proposed in the 1970s. However, cultivation of human CECs (HCECs) in sufficient quantity and with acceptable quality for clinical use has proven surprisingly difficult, and the development of methods for transplanting cultured HCECs has been necessary. Numerous research groups have developed culture protocols and techniques that are now bringing corneal endothelial regeneration closer to real-world therapy. For instance, we started a clinical trial in 2013 involving the injection of cultured HCECs into the anterior chamber of patients with corneal endothelial decompensation. This review outlines the rapid progression of this research field, including clinical trial results, and is also intended to identify topics that still require further research or discussion.

KEYWORDS:

• Corneal endothelium
• tissue engineering
• regeneration

Acknowledgments

The authors thank Dr. Shigeru Kinoshita, Dr. Chie Sotozono, Dr. Morio Ueno, Dr. Junji Hamuro, Dr. Takahiro Nakamura, Dr. Hiroko Nakagawa, Dr. Michio Hagiya, Dr. EunDuck P. Kay, Dr. Makiko Nakahara, Mr. Junji Kitano, Mr. Ryohei Numata, Mr. Hiroatsu Hirano, Mr. Shinichiro Nakano, Mr. Ryota Inoue, Mr. Kazuya Kakutani, Ms. Ayaka Kusakabe, Ms. Akane Hongo, Mr. Yugo Okazaki, Mr. Takato Kagami, Mr. Daiki Matsumoto, Mr. Tomoki Shimada, Mr. Kensei Fukushima, Mr. Hirofumi Imai, Mr. Hiroaki Kobayashi, Mr. Tetta Kurosawa, Dr. Yuji Sakamoto, Dr. Shinichiro Nakamura for their invaluable advice and contributions.

Disclosure statement

The authors declare that there are no conflicts of interest.