Corneal diseases are among the leading causes of reversible blindness worldwide. When conservative treatment options fail, many eyes can be treated with corneal transplantation. Historically, full... Show moreCorneal diseases are among the leading causes of reversible blindness worldwide. When conservative treatment options fail, many eyes can be treated with corneal transplantation. Historically, full thickness corneal transplantation, in which all corneal layers are replaced, has been the mainstay of care in the treatment of corneal endothelial disorders. In the past two decades, however, there has been a trend towards the selective, less invasive replacement of only the diseased, rather than all corneal layers. These partial thickness corneal transplantations are known as lamellar keratoplasties. Lamellar keratoplasty has significantly improved the clinical outcomes, such as visual acuity, after transplantation. Since its introduction in 1998, lamellar keratoplasty has evolved from Deep lamellar endothelial keratoplasty to Descemet membrane endothelial keratoplasty (DMEK). Globally, however, there is only one donor cornea available for 70 people in need. This shortage inspired further refinement of conventional DMEK and led to the development of adapted DMEK-techniques, which may increase the availability of endothelial donor grafts. This thesis focuses on donor tissue preparation for DMEK and evaluates the feasibility and clinical outcomes of DMEK, DMET, Hemi-DMEK and Quarter-DMEK in the management of corneal endothelial disorders. Show less
This thesis focuses on the clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK). Chapter 2 describes the suitability of septic donor corneas for transplantation and the... Show moreThis thesis focuses on the clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK). Chapter 2 describes the suitability of septic donor corneas for transplantation and the clinical outcomes after DMEK using septic versus non-septic donor corneas. Chapter 3 aims to analyze the incidence of cataract extraction in eyes that previously underwent DMEK surgery and the effect of the phacoemulsification procedure on the endothelial cell density (ECD) after DMEK. Chapter 4 of the thesis concentrates on the 6-month ECD after DMEK, as it is one of the benchmark parameters for graft performance. In this chapter, the relation between the ECD 6 months after DMEK and its predictive value for 5-year graft survival in FECD eyes are discussed. Chapter 5 evaluates the 10-year graft survival and clinical outcome results of the first 100 eyes that received DMEK. Chapter 6 presents a larger case series of DMEK eyes where the 10-year clinical outcomes and graft survival after DMEK are analyzed based on the surgical indication of the eye and the preoperative severityof FECD. Show less
The thesis focuses on the in vivo and in vitro behavior of corneal endothelial cells before and after endothelial keratoplasty. The first part of the project concentrates on the ECD decrease after... Show moreThe thesis focuses on the in vivo and in vitro behavior of corneal endothelial cells before and after endothelial keratoplasty. The first part of the project concentrates on the ECD decrease after DMEK and DMEK graft viability prior to transplantation. The second part focusses on regenerative strategies for the treatment of FECD by developing and applying in vitro cell migration assays. In vitro cell migration from DMEK grafts of various sizes and shapes are investigated in a 3D cell culture system aiming to identify critical parameters for the successful clinical application of corneal endothelial therapies. Show less
Corneal transplantation still represents the elected method for the treatment of corneal endothelial pathologies. However, the worldwide shortage of donor corneas induced the exploration of... Show moreCorneal transplantation still represents the elected method for the treatment of corneal endothelial pathologies. However, the worldwide shortage of donor corneas induced the exploration of approaches to use the donor tissue more efficiently or to be more independent from donor tissue. This thesis will illustrate the improvements of new strategies for cell-based corneal endothelial regeneration, alternative to corneal endothelial surgical transplantation, by bridging the gap between in vitro experiments and clinical models. In the studies described, we first address the establishment of a GMP-compliant protocol for in vitro hCEC culture for clinical application and then we focus on endothelial cell sheet transplantation, describing both in vitro and in vivo applications of expanded CEC-carriers constructs made by biocompatible materials. Show less
