Improved surgery technique for endothelial disease of the cornea

In a research presentation today at the American Academy of Ophthalmology's Annual Meeting, Massimo Busin, MD, department head and professor of ophthalmology at the Villa Serena Hospital, Forli, Italy, described a technique that significantly improved results in patients being treated for endothelial disease of the cornea, the transparent covering of the front of the eye that provides much of its optical power.

When the cell density in the endothelial layer is reduced below a level compatible with its normal function, the cornea swells and becomes less transparent, and vision is impaired.

Since endothelial cells do not regenerate, the disease is treated by transplanting healthy donor tissue. The standard approach has been complete cornea transplantation (PK, or penetrating keratoplasy). Today, DSAEK (descemet-stripping automated endothelial keratoplasy)---where only endothelial tissue attached to a thin layer of deep stroma is transplanted and the normal structure of the recipient cornea is not disrupted--is increasingly preferred by corneal surgeons. Most patients receiving DSAEK recover good vision within weeks (versus six months to a year with PK), and the risk of complications during and after surgery is minimized. A significant drawback of DSAEK, though, has been the limited survival of the transplanted endothelium, with a reduction of up to 50 % of preoperative density as early as six months after DSAEK.

Dr. Busin described a modified DSAEK technique developed by his group that resulted in rates of donor endothelial cells survival equivalent to PK.

“Our approach reduced the rate of endothelial cell loss in the transplanted tissue to an average of 23% at one year post-surgery, which is similar to values recorded after PK,” said Dr. Busin. “Our ‘pull through' technique simplifies the DSAEK procedure and, more importantly, resolves the main obstacle that has delayed corneal surgeons' transition to DSAEK.”