The less invasive procedure than the transplant and allows a faster recovery, but suitable for treating only pathologies of the deep layer of the cornea. The European experimentation kicks off in Italy at the beginning of 2023
Will it be possible to do without corneal transplantation, at least for diseases that compromise the deepest part? the promise of one new technique which was discussed at the national congress of the Italian Society of Ophthalmological Sciences (SISO) and which will shortly begin in Italy the European experimentation path for approval for use in clinics: no transplant, but a simple injection of endothelial cells donor corneal. A revolution not only for the technique, simpler and less invasive, but also for the possibility of treat up to 500 patients with tissue extracted from a single donortwo elements that could make a difference in developing countries.
How does it work
The simple idea: when the defect is in the innermost layer of corneal tissue, called the endothelium, the cells that compose it can be transplanted instead of replacing the whole cornea. Managing cells is much simpler than using whole tissue, for various reasons: endothelial cells can be extracted from donors and made multiply in culture, therefore, starting from a single donor, many are obtained which can be available for many patients; moreover, the transplantation of a sheet of tissue involves greater operating difficulties than the simple injection, made after scraping off the recipient’s diseased corneal endothelial cells. The technique can help when there are alterations in the deep corneal layer as well just retrieve this to get back to seeing: it occurs in about 40 percent of corneal transplant candidates and the case for example of Fuchs endothelial dystrophy, a hereditary disease that appears in the third age, or the rare bullous keratopathy. However, this is not the case for keratoconus, in which the alterations concern the intermediate layer of the cornea, explains Vincenzo Sarnicola, the member of the SISO board of directors who in 2023 will be the first in Europe to operate on patients. When the pathology concerns only the endothelial layer, intervening with a cell transplant will be decisive and much simpler than the standard transplant: the procedure for the injection into the anterior ocular chamber lasts a few minutes, then the patient must be kept prone for three hours during which the endothelial cells realign themselves autonomously in the tissue. The fastest and best visual recovery.
From a single donor
The multiplication of ‘healing’ cells in culture is estimated to allow for treatment from three hundred to five hundred patients with only one donor cornea, a significant advantage because, as Sarnicola explains, it will be possible to treat many more patients than today and it will help especially in developing countries, where finding the necessary corneal tissues is not easy and managing standard corneal transplants just as complex. . In the world there are 13 million people with bilateral blindness due to corneal diseases and in 40-50 percent of cases it is a malfunction of the endothelium: to develop a technique that allows you to treat up to five hundred people with a single donor and a simple injection has the potential to help eradicate corneal blindness significantly. The technique, invented in Japan by Shigeru Kinoshita of Kyoto University, used on 65 Japanese patients followed up to date for five years; recently the trial landed in the United States where Edward Holland, ophthalmologist at the University of Cincinnati, treated fifty cases starting from just two corneas; the good results obtained have paved the way for the US experimentation, still in progress, to obtain the green light from the Food and Drug Administration which is expected for the end of 2022. Therefore, it is not a technique that will be available shortly, but it is a innovation that could help many patients in the future.
May 26, 2022 (change May 26, 2022 | 17:31)
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