Corneal-Cell Injection Ongoing Success in Bullous Keratopathy

By Reuters Staff

September 23, 2020

NEW YORK (Reuters Health) - Most patients who underwent injection of cultured human corneal endothelial cells (hCECs) more than five years ago because of corneal endothelial failure continue to do well, according to researchers in Japan.

Their approach also involves simultaneous injection of a Rho-associated protein kinase (ROCK) inhibitor to be used as an adjunctive drug to promote corneal endothelial cell engraftment.

Previous findings show the treatment was successful at two years, Dr. Shigeru Kinoshita of Kyoto Prefectural University of Medicine and colleagues note in Ophthalmology. They now update their findings in 11 eyes of 11 patients with pseudophakic endothelial failure conditions who underwent hCEC-injection therapy between 2013 and 2014.

Seven of the patients had presented with Fuchs endothelial corneal dystrophy, two had argon laser iridotomy-induced corneal edema, one had pseudoexfoliation syndrome and the remaining patient had intraocular surgery-related corneal edema. They were initially followed for a number of weeks after surgery and then annually for five years.

Over the course of follow-up, "excellent" corneal restoration with good best-corrected visual acuity (BCVA) was continuously maintained in 10 of the 11 treated eyes, the team reports. During follow-up there were no local or systemic adverse events, such as immunological endothelial rejection, uveitis, or infection.

Normal corneal endothelial function was restored in 10 of the eyes and BCVA was significantly improved in these eyes. In addition, the endothelial cell density was significantly improved in 10 of the eyes.

No increase in intraocular pressure (IOP) was seen other than in one patient at eight months postoperatively in response to topical steroids. Following a corrective procedure IOP returned to the normal range with no need of anti-glaucoma eye-drop medication.

Given that corneal transparency was restored and maintained without major adverse events during the five-year-postoperative period, the researchers "firmly believe that our new cultured hCEC injection therapy is a paradigm shift in corneal regenerative medicine, with potential clinical application to patients worldwide, as it allows for enough hCECs to treat at least 300 diseased eyes to be cultured from just 1 donor cornea."

The study did not have commercial funding.

Dr. Kinoshita did not respond to requests for comments.

SOURCE: Ophthalmology, online September 6, 2020.