ESCRS - FP05.07 - CLINICAL OUTCOMES OF ARTIFICIAL CORNEAL ENDOTHELIAL TRANSPLANT IN A TERTIARY REFERRAL CENTRE

Purpose

To evaluate the safety and efficacy of artificial endothelial layer implantation (EndoArt) for the treatment of chronic corneal oedema in high-risk eyes with multiple failed grafts and complex ocular comorbidities at a tertiary referral centre.

Setting

Tertiary referral ophthalmology department, Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom.

Methods

This retrospective case series included 14 eyes of 14 patients (mean age 73.2 ± 16.0 years) who underwent EndoArt implantation for chronic corneal oedema between December 2024 and October 2025. Primary outcome measures included best-corrected distance visual acuity (BCDVA) in logMAR, central corneal thickness (CCT) in micrometres, and surgical complications. Mean follow-up was 4.2 months (range 0-10 months).

Results

Indications: The cohort comprised 64.3% (9/14) eyes with previous failed grafts including penetrating keratoplasty (n=4), Descemet membrane endothelial keratoplasty (n=4), and Descemet stripping automated endothelial keratoplasty (n=2). The primary indications were Fuchs endothelial dystrophy in 21.4% (3/14) of eyes, pseudophakic bullous keratopathy in 14.3% (2/14) of eyes, and infectious keratitis (fungal, herpes simplex, and varicella zoster) in 21.4% (3/14) of eyes. Associated comorbidities included glaucoma with drainage devices in 28.6% (4/14) eyes, pseudoexfoliation in 14.3% (2/14) eyes, complex cataract surgery complications in 14.3% (2/14) eyes, vitreoretinal surgery history in 14.3% (2/14) eyes, and aniridia in 7.1% (1/14) eyes. Visual and anatomical outcomes: In eyes with complete data (n=4), BCDVA improved significantly from 1.82 ± 0.57 logMAR preoperatively to 0.85 ± 0.77 logMAR postoperatively, representing a mean improvement of 0.98 logMAR. Visual acuity improved in 75% of eyes. In paired CCT analysis (n=3), mean CCT decreased from 819 ± 91 µm preoperatively to 621 ± 83 µm at 6 months postoperatively, representing a 24.2% reduction (198 µm). Complications: Resuturing was required in 22.2% (2/9) of eyes. No eyes required rebubbling (0/8). Mean intraocular pressure at last follow-up was 17.5 ± 0.7 mmHg. No device-related infections or severe complications occurred during the follow-up period.

Conclusion

EndoArt implantation demonstrated promising early outcomes in this high-risk cohort with previous graft failures and complex ocular comorbidities. The procedure resulted in significant improvements in visual acuity and corneal thickness with a low complication rate. These findings support EndoArt as a viable alternative for treating chronic corneal oedema in eyes with poor prognosis for conventional keratoplasty. Longer follow-up is warranted to evaluate long-term device stability and visual outcomes.