New developments in corneal endothelial cell replacement

Daniele Spinozzi, Alina Miron, Marieke Bruinsma, Isabel Dapena, Viridiana Kocaba, Martine J. Jager, Gerrit R.J. Melles, Sorcha Ni Dhubhghaill, Silke Oellerich

Research output: Contribution to journalScientific reviewpeer-review

5 Citations (Scopus)


Corneal transplantation is currently the most effective treatment to restore corneal clarity in patients with endothelial disorders. Endothelial transplantation, either by Descemet membrane endothelial keratoplasty (DMEK) or by Descemet stripping (automated) endothelial keratoplasty (DS(A)EK), is a surgical approach that replaces diseased Descemet membrane and endothelium with tissue from a healthy donor eye. Its application, however, is limited by the availability of healthy donor tissue. To increase the pool of endothelial grafts, research has focused on developing new treatment options as alternatives to conventional corneal transplantation. These treatment options can be considered as either ‘surgery-based’, that is tissue-efficient modifications of the current techniques (e.g. Descemet stripping only (DSO)/Descemetorhexis without endothelial keratoplasty (DWEK) and Quarter-DMEK), or ‘cell-based’ approaches, which rely on in vitro expansion of human corneal endothelial cells (hCEC) (i.e. cultured corneal endothelial cell sheet transplantation and cell injection). In this review, we will focus on the most recent developments in the field of the ‘cell-based’ approaches. Starting with the description of aspects involved in the isolation of hCEC from donor tissue, we then describe the different natural and bioengineered carriers currently used in endothelial cell sheet transplantation, and finally, we discuss the current ‘state of the art’ in novel therapeutic approaches such as endothelial cell injection.

Original languageEnglish
Pages (from-to)712-729
Number of pages18
JournalActa Ophthalmologica
Issue number7
Publication statusPublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


  • cornea
  • corneal endothelium
  • tissue engineering
  • transplantation


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