Long-term outcome of cultured corneal endothelial cell transplantation with descemetorhexis: A 10-year follow-up study

Purpose: To describe the 10-year clinical course after cultured human corneal endothelial cell (CEC) (cHCEC) transplantation combined with central descemetorhexis in a single patient with Fuchs endothelial corneal dystrophy (FECD). Observations: A 49-year-old Japanese male was referred to the Department of Ophthalmology at Kyoto Prefectural University of Medicine, Kyoto, Japan in 2013 due to decreased visual acuity (VA) and CEC loss in his left eye caused by FECD. Upon examination, FECD-related central corneal edema, cataract, and decreased VA were observed, and on September 4, 2014 the patient underwent cHCEC transplantation in his left eye. Intraoperatively, a Descemet membrane (DM) tear occurred while abnormal CECs were being removed, thus requiring a change in the surgical plan. Subsequently, the DM was completely stripped (descemetorhexis) in an approximately 5-mm-diameter area including the pupillary center, followed by cHCEC transplantation into the anterior chamber. Prior to surgery, best-corrected VA (BCVA) was 20/50 and central corneal thickness (CCT) was 637 μm, yet corneal transparency was restored and BCVA improved to 20/20 at 6-months postoperative. At 10-years postoperative, a reasonable CEC density (CECD) was found to have adhered to the descemetorhexis area, with maintained corneal transparency; i.e., CCT measured 548 μm, CECD in the central area was 938 cells/mm2, and BCVA remained stable at 20/13. Conclusion and importance: While prospective studies are needed to generalize safety and efficacy, this FECD case treated with cHCEC transplantation combined with descemetorhexis showed no serious adverse events and sustained corneal clarity with stable CECD and CCT.