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Letter Regarding: Artificial Endothelial Layer Implantation After Multiple Failed Keratoplasties

Letter Regarding: Artificial Endothelial Layer Implantation After Multiple Failed Keratoplasties LETTERS TO THE EDITOR linking modifications. Collagen repre- plants, can lead to even better results Letter Regarding: sents the major structural protein in the and broader acceptance, thus offering Artificial Endothelial cornea, allowing for high biocompatibil- a viable alternative for those patients ity and mechanical properties. Using 3D afflicted by endothelial dysfunction. Layer Implantation printing technology, it is possible to This strategy has the potential to change create custom implants matching the the corneal transplantation field and After Multiple Failed specific anatomical and pathological offer hope to those patients who have Keratoplasties needs of individual patients. Such pre- otherwise been given up on under cision fabrication might enable better traditional therapeutic means. host tissue integration and visual out- Financial disclosures/conflicts of inter- comes. Further stability of collagen im- To the Editor: est: The author declares no conflicts of plants can be achieved through cross- I am writing to comment on the linking modifications. Chemical cross- interest related to the content of this recently published case report titled linkers, like carbodiimides, and physical letter. The insights and suggestions pro- “Artificial Endothelial Layer Implanta- methods, such as UV irradiation, dra- vided are based on a review of recent tion After Multiple Failed Keratoplas- 1 matically increase the mechanical ties.” This pilot study describes the first advancements in the field and are in- strength and resistance to enzymatic experience of the application of an tended to contribute to the ongoing degradation of collagen. Such modifica- alternative, noncellular corneal endothe- discussion and development of tions would render the artificial endo- lial substitute in a patient with a history improved materials and techniques for thelial layer functional over a long of multiple graft rejections, including 2 lamellar keratoplasty. There has been no period, hence reducing cases of repeat failed penetrating keratoplasties and 1 financial support or other benefits from surgeries and increasing general patient rejected Descemet stripping automated commercial sources directly or indirectly satisfaction. endothelial keratoplasty. The implanta- related to the subject of this letter. This 3D printing, combined with tion of a bioengineered endothelium the latest cross-linking methods, has layer is, therefore, a milestone in corneal potential for corneal grafting. The pos- Sreehari Suresh, PhD transplantation and holds promise for sibility of fabrication of highly individ- patients with multiple graft failures. The Saveetha Medical College and Hospital, ual and reliable biocompatible implants 12-month follow-up, showing the im- Saveetha Institute of Medical and Technical will lead to much better acceptance plant’s stability with a reduction in Sciences (SIMATS), Chennai, Tamil Nadu, rates, in particular for patients with central corneal thickness, underlines India a history of graft rejections. This mod- the potential of this innovative approach ification of the collagen concerning to hold out a viable alternative to REFERENCES mechanical properties and stability will classical lamellar endothelial kerato- 1. Rens J, Krolo I, Koppen C, et al. Artificial provide better implants that are a reliable, endothelial layer implantation after multiple plasty. The simplicity of the implanta- long-term solution, potentially overcom- failed keratoplasties. Cornea. 2024;43: tion technique and the persistence of the 790–794. ing the shortcomings noticed with the deswelling effect on the cornea makes 2. Wu H, Wang J, Fan W, et al. Eye of the future: existing noncellular and cellular grafts. this novel solution practical and effec- unlocking the potential utilization of hydrogels In conclusion, this case report tive despite the ocular comorbidities in intraocular lenses. Bioeng Transl Med. 2024; presents a significant breakthrough in 9:e10664. presented. 3. Zhao J, Xiong J, Ning Y, et al. A triple corneal transplantation in the form of an Future investigation might pro- crosslinked micelle-hydrogel lacrimal implant artificial endothelial layer. Moreover, ceed 1 step further and test the potential for localized and prolonged therapy of glau- future research in this area, focusing on of 3D-printed collagen-based artificial coma. Eur J Pharm Biopharm. 2023;185: 3D-printed, cross-linked collagen im- 44–54. endothelial layers, improved with cross- Cornea Volume 00, Number 00, Month 2024 www.corneajrnl.com 1 Copyright © 2024 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Cornea Wolters Kluwer Health

Letter Regarding: Artificial Endothelial Layer Implantation After Multiple Failed Keratoplasties

Suresh, Sreehari
Cornea , Volume 43 (12) – Dec 16, 2024
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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1536-4798
eISSN
0277-3740
DOI
10.1097/ico.0000000000003657
Publisher site
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Abstract

LETTERS TO THE EDITOR linking modifications. Collagen repre- plants, can lead to even better results Letter Regarding: sents the major structural protein in the and broader acceptance, thus offering Artificial Endothelial cornea, allowing for high biocompatibil- a viable alternative for those patients ity and mechanical properties. Using 3D afflicted by endothelial dysfunction. Layer Implantation printing technology, it is possible to This strategy has the potential to change create custom implants matching the the corneal transplantation field and After Multiple Failed specific anatomical and pathological offer hope to those patients who have Keratoplasties needs of individual patients. Such pre- otherwise been given up on under cision fabrication might enable better traditional therapeutic means. host tissue integration and visual out- Financial disclosures/conflicts of inter- comes. Further stability of collagen im- To the Editor: est: The author declares no conflicts of plants can be achieved through cross- I am writing to comment on the linking modifications. Chemical cross- interest related to the content of this recently published case report titled linkers, like carbodiimides, and physical letter. The insights and suggestions pro- “Artificial Endothelial Layer Implanta- methods, such as UV irradiation, dra- vided are based on a review of recent tion After Multiple Failed Keratoplas- 1 matically increase the mechanical ties.” This pilot study describes the first advancements in the field and are in- strength and resistance to enzymatic experience of the application of an tended to contribute to the ongoing degradation of collagen. Such modifica- alternative, noncellular corneal endothe- discussion and development of tions would render the artificial endo- lial substitute in a patient with a history improved materials and techniques for thelial layer functional over a long of multiple graft rejections, including 2 lamellar keratoplasty. There has been no period, hence reducing cases of repeat failed penetrating keratoplasties and 1 financial support or other benefits from surgeries and increasing general patient rejected Descemet stripping automated commercial sources directly or indirectly satisfaction. endothelial keratoplasty. The implanta- related to the subject of this letter. This 3D printing, combined with tion of a bioengineered endothelium the latest cross-linking methods, has layer is, therefore, a milestone in corneal potential for corneal grafting. The pos- Sreehari Suresh, PhD transplantation and holds promise for sibility of fabrication of highly individ- patients with multiple graft failures. The Saveetha Medical College and Hospital, ual and reliable biocompatible implants 12-month follow-up, showing the im- Saveetha Institute of Medical and Technical will lead to much better acceptance plant’s stability with a reduction in Sciences (SIMATS), Chennai, Tamil Nadu, rates, in particular for patients with central corneal thickness, underlines India a history of graft rejections. This mod- the potential of this innovative approach ification of the collagen concerning to hold out a viable alternative to REFERENCES mechanical properties and stability will classical lamellar endothelial kerato- 1. Rens J, Krolo I, Koppen C, et al. Artificial provide better implants that are a reliable, endothelial layer implantation after multiple plasty. The simplicity of the implanta- long-term solution, potentially overcom- failed keratoplasties. Cornea. 2024;43: tion technique and the persistence of the 790–794. ing the shortcomings noticed with the deswelling effect on the cornea makes 2. Wu H, Wang J, Fan W, et al. Eye of the future: existing noncellular and cellular grafts. this novel solution practical and effec- unlocking the potential utilization of hydrogels In conclusion, this case report tive despite the ocular comorbidities in intraocular lenses. Bioeng Transl Med. 2024; presents a significant breakthrough in 9:e10664. presented. 3. Zhao J, Xiong J, Ning Y, et al. A triple corneal transplantation in the form of an Future investigation might pro- crosslinked micelle-hydrogel lacrimal implant artificial endothelial layer. Moreover, ceed 1 step further and test the potential for localized and prolonged therapy of glau- future research in this area, focusing on of 3D-printed collagen-based artificial coma. Eur J Pharm Biopharm. 2023;185: 3D-printed, cross-linked collagen im- 44–54. endothelial layers, improved with cross- Cornea Volume 00, Number 00, Month 2024 www.corneajrnl.com 1 Copyright © 2024 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

Journal

Cornea – Wolters Kluwer Health

Published: Dec 16, 2024

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