Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Asia Pac J Ophthalmol (Phila). 2019 Nov-Dec;8(6):441-447. doi: 10.1097/APO.0000000000000265.
The cornea is the major focusing structure of the human eye and the corneal endothelium maintains the relatively dehydrated state of the cornea required for clarity. The endothelial cells respond to disease or injury by migration and cellular enlargement. Our current understanding is that there is a very limited degree of proliferative or regenerative capacity in the human corneal endothelium. Thus, corneal endothelial diseases may result in corneal edema, significantly impact vision and quality of life. Contemporary surgical transplantation options for treating moderate to advanced endothelial dysfunction include penetrating keratoplasty (PK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty. Advances in surgical techniques aim to bring faster visual recovery and improve visual outcomes; however, there is still a significant donor cornea shortage worldwide and alternative methods for treatment for corneal endothelial disease are rapidly evolving. Indeed, we are at a pivotal point in corneal transplantation for endothelial disease and novel surgical strategies include using 1 donor for multiple recipients, a minimally attached endothelial graft, and Descemet membrane stripping only. Crucially, forthcoming approaches include the use of Rho-Kinase (ROCK) inhibitors, endothelial cell therapy, tissue engineered grafts, and consideration of stem cell techniques. Ultimately, the choice of technique will be dependent on recipient factors such as age, type of endothelial disease, extent of the disease, and associated ocular disorders. The safety and efficacy of these rapidly developing treatments warrant further investigations. In time, some or all of these alternatives for corneal transplantation will alleviate the reliance on limited corneal donor tissue.
角膜是人类眼睛的主要聚焦结构，角膜内皮细胞维持着角膜的相对脱水状态，这是保持其清晰的必要条件。内皮细胞通过迁移和细胞增大来应对疾病或损伤。我们目前的理解是，人类角膜内皮细胞的增殖或再生能力非常有限。因此，角膜内皮疾病可能导致角膜水肿，显著影响视力和生活质量。治疗中度至重度内皮功能障碍的当代手术移植选择包括穿透性角膜移植术（PK）、撕囊内皮角膜移植术（DSEK）和 Descemet 膜内皮角膜移植术。手术技术的进步旨在带来更快的视觉恢复和改善视觉效果；然而，全球仍然存在显著的供体角膜短缺，治疗角膜内皮疾病的替代方法正在迅速发展。事实上，我们正处于角膜内皮疾病移植的关键阶段，新的手术策略包括为多个受者使用 1 个供体、附着最小的内皮移植物和仅进行 Descemet 膜剥离。至关重要的是，即将出现的方法包括使用 Rho 激酶（ROCK）抑制剂、内皮细胞治疗、组织工程移植物以及考虑干细胞技术。最终，技术的选择将取决于受者的因素，如年龄、内皮疾病的类型、疾病的程度和相关的眼部疾病。这些快速发展的治疗方法的安全性和有效性需要进一步的研究。随着时间的推移，这些角膜移植的替代方法中的一些或全部将减少对有限的角膜供体组织的依赖。
