New simple procedure may replace cornea transplant

Washington: A new, minimally invasive, procedure without potential side effects can replace the need for a corneal transplant for treatment of eye diseases,
researchers have said.

Scientists led by Kathryn Colby from University of Chicago in the US showed that removing a few square millimetres of a single layer of cells on the inside of the
cornea allowed rejuvenation of the surrounding tissue, without the need for a corneal transplant. This simple procedure restored clear vision to three out of four patients suffering from Fuchs endothelial dystrophy (FED), researchers said.

Over the past two years while at Harvard Medical School in the US, Colby performed the new procedure, known as Descemet stripping, on 11 patients, aged 51 to 91. Two patients had the procedure in both eyes, one at a time.
When assessed six months after the operation, ten of the treated eyes (77 per cent) had clear corneas and eight had 20/20 vision or better (two patients had retinal disease that limited their final vision), researchers said.

"It is quick, inexpensive and it spares patients from having someone else's cells in their eyes, which requires local immunosuppression," said Colby. The first patient to undergo Descemet stripping, Eric Thorp, 69 called it a "breakthrough."
His vision, now 20/20 in that eye, "is equivalent to what I had as a boy," he said.

Descemet stripping involves removing a small patch of the corneal endothelium (the pumping cells that stop working in FED) attached to an underlying layer (the Descemet membrane). In patients with FED, water accumulates in the cornea,
the clear front window of the eye, because of the dysfunction of the pumping cells, causing reduced vision, glare and haloes. If left untreated, the condition progresses to painful blindness, researchers said.

Removal of the central dysfunctional cells enables healthier peripheral cells to migrate to the centre of the cornea, where they reestablish pumping capacity and removal of fluid from the layers above. This gradually restores clear vision, they said. "Although Descemet stripping is a relatively simple procedure, its potential is revolutionary," said Colby. The findings were published in the journal Cornea.