Replacement of the Corneal Endothelium and the Conceptual Framework for an Artificial Substitute

Abstract

Dysfunction of the corneal endothelium due to cell loss caused by aging, disease or trauma can lead to severe visual impairment and blindness. Traditionally, dysfunctional endothelia are managed surgically, by removing the entire central cornea and transplanting either donor corneal tissue (penetrating keratoplasty), or just endothelia isolated from donor corneas. As in many cases it is only the corneal endothelium requiring replacement, many attempts were made over the last decades to develop an endothelial substitute, thereby precluding the need for the use of full donor corneas. This article reviews these attempts, which include artificial membranes, cell-coated corneal transplants, and cell-coated membranes. The presumption of an artificial corneal endothelium capable of duplicating the transendothelial ion-and-fluid transport function is examined in light of the latest hypotheses regarding the mechanism of this function.