The Endoart: A Real-World Evidence And Interim Results From A Case Series.

Purpose: To report the interim outcomes of my personal experience in real life implantation of the EndoArt (endothelial keratoprosthesis).

Cornea Unit, Department of Ophthalmology, Academic setting, Soroka University Medical Center, Ben-Gurion University of Negev, Beer-Sheva, Israel. 

Methods: Prospective case series of 13 patients with endothelial failure, and poor visual acuity caused by posterior segment pathology, were included. Previous glaucoma or corneal surgery was an exclusion criterium. The outcome measures were implant adherence, safety and improving of central corneal thickness on OCT and visual acuity. The Endoart functions as a mechanical barrier preventing seepage of fluids form the AC into the corneal stroma. 4 patients underwent combined (Phacoemulsification with PC IOL and Endoart implantation) surgery.

The EndoArt device was implanted in 13 patients (9 with Bullous Keratopathy and 4 with Fuchs dystrophy). In all 13 patients the EndoArt remained adherent throughout the study period. Follow-up time ranges from 6 to 18 months. Central cornea thickness as observed by OCT was reduced by a mean of 36%, from an average of 750.0 microns to 481.6 microns. Visual acuity was improved from an average 1.85 LogMAR (Finger Count) pre-operatively, to 0.34 LogMAR during the post-surgery follow-up. In all 13 cases, single intracorneal sutures and intracameral C3F8 were used to aid initial adherence of the implant. In 3 patients (25%) one re-bubbling procedure was needed post-operatively.

 In all patients we observed alleviation of stromal edema and improvement in visual acuity. No pathological thinning, toxic reactions, opacification of the cornea or other side effects, or complications were seen with either patients with EndoArt implantation only, or patients who underwent a   combined surgery of EndoArt implantation and cataract extraction. The EndoArt is a novel device that will allow treatment of more patients with endothelial disease as compared with donor tissue (banking) availability. This treatment modality has promising results, but still stays during the development steps.