4mm Descemetorhexis and anterior lens capsule graft versus descemet striping only: A preclinical study

Aims/Purpose: Fuchs endothelial corneal dystrophy is currently the main indication for keratoplasty. Alternatively, a localized 4mm Descemet Stripping Only (DSO) has been proposed to treat selected patients with a sufficient peripheral endothelial reserve (1,2). Visual recovery is generally longer than after keratoplasty but no immunosuppressive treatment is needed (3). The anterior lens capsule (ALC) can be used as a support for the culture of corneal endothelial cells (CECs)(4). Their migration is facilitated by the presence of a basal membrane. Aim: to assess the migration capacity of CECs with and without the addition of an ACL disc after a 4mm Descemetorhexis in an ex vivo modelMethods: Pairs of human corneas procured for scientific purposes were used. The ACL were procured during femtosecond laser assisted cataract surgery and decellularized in water. Corneas were deswelled for 72h in our Active Storage Machine (ASM)(5). A central 4mm Descemetorhexis was performed. For each pair, one cornea received a 4mm ALC disc. The corneas were then placed back in the ASM with air tamponade for 72h. All corneas were then stored for 14 days in CorneaMax (Eurobio) and monitored by OCT. The endothelium was finally assessed using: 1/Hoechst 33342, Calcein‐AM and trypan blue staining for cell viability; 2/alizarin red staining for cell morphology; 3/immunostaining targeted CEC membrane proteins, mesenchymal transition markers and keratocytes.Results: Migration of CEC on the surface of the ALC was more extensive than on the bare stroma. Migrating cells were usually polynucleated and polygonal in both groups. Peripheral viable CECs (Calcein +) were comparable in both groups. Central corneal thicknesses were not statistically different.Conclusions: The presence of a ALC allows more extensive migration of CECs after 14 days in ASM compared with the DSO. The use of a decellularized ALC disc could therefore allow faster visual recovery for selected FECD patients eligible for DSO, particularly during combined cataract surgery.ReferencesBorkar et al. Cornea. 2016 Oct; 35(10): 1267–73.Iovieno et al. Can J Ophthalmol. 2022 Dec; 57(6): 402–7.Huang et al. Cornea. 2018 Dec; 37(12): 1479–83.Yoeruek et al. Cornea. 2009 May; 28(4): 416.Garcin T et al. Am J Transplant. 2019 Jun; 19(6): 1641–51.