Artificial Endothelial Layer Transplantation: Early Clinical Experience

To evaluate clinical efficacy and feasibility of artificial flexible, thin (50µ) corneal layer (EndoArt- EyeYon Medical, Israel) substituting damaged corneal endothelium in cases of pseudophakic bullous keratopathy and persistent corneal edema.

Georgian National Eye Institute DAVINCI

EndoArt has been implanted in 4 eyes of four patients having pseudophakic bullous keratopathy and persistent corneal edema. All patients were previously operated with trabeculectomy for advanced glaucoma. After Descemet’s membrane stripping from central 7.0mm zone EndoArt was implanted through the clear corneal incision and suture fixated onto the internal surface of the cornea. Non-expansile concentration of C3F8 (10%) gas was used to facilitate implant fixation and inferior iridectomy was performed to prevent postoperative pupillary block. BCVA and central corneal thickness (CCT) were measured in day one, 1 week, 2 weeks and monthly after implantation. All patients crossed 2 months follow up. 

Mean BCVA was improved in all patients, which was varied from 0.001 preoperatively to 0.08 in 2 months postoperatively. Limited restoration of vision was caused by existing advanced glaucoma in all cases. CCT was reduced in all cases where mean preoperative thickness was 786µ and mean postoperative thickness was 558µ. Implant dislocation was observed in one case at 1 month follow up, which was managed by gas reinjection and relocation. Gas reabsorbtion time varied form 1 week to 1 month (mean 23 days). Epithelial Bullae and pain was vanished in all cases.

The EndoArt hydrophilic acrylic implant as a substitute of damaged endothelium seems to be efficient in management of corneal decompensation and bullous keratopathy. Procedure itself has short learning curve. However, more number of cases and longer follow up is required to make more solid statements.