Corneal endothelial cell failure remains a significant challenge after Descemet stripping automated endothelial keratoplasty (DSAEK). While repeat keratoplasty is the standard treatment, it relies heavily on donor availability and carries surgical risks. Recently, corneal endothelial cell therapy has emerged as a promising regenerative alternative. A prospective case series published in JAMA Ophthalmology explores its potential for eyes where initial grafts have failed.

Clinical Success of Corneal Endothelial Cell Therapy

Specifically, the study evaluated four eyes treated with cultured human corneal endothelial cell (HCEC) injections. Researchers observed remarkable improvements in visual outcomes. For instance, the mean best-corrected visual acuity (BCVA) improved from 20/1700 preoperatively to 20/60 at three months. This change represents a gain of 15 Snellen lines, which significantly enhances the patient's quality of life.

Furthermore, the therapy successfully reduced central corneal thickness (CCT). Preoperative measurements averaged 900 µm, but these dropped to 641 µm following the injection. This reduction indicates that the injected cells effectively restored the cornea's pumping mechanism. Consequently, endothelial cell density (ECD) reached a healthy mean of 2150 cells/mm² by the three-month follow-up.

Managing Post-Procedural Complications

Notably, the procedure demonstrated a favorable safety profile. Although clinicians observed cystoid macular edema in two eyes, they managed it effectively using topical diclofenac and triamcinolone injections. Furthermore, the study reported no instances of infection, intraocular pressure elevation, or graft detachment. These findings suggest that the injection approach is less invasive and potentially safer than repeat surgical grafting.

Future Implications for Ocular Regeneration

However, the researchers emphasize that this was a small pilot study. While the results are encouraging, clinicians need larger controlled trials with longer follow-up periods to confirm these benefits. If validated, corneal endothelial cell therapy could solve the global donor shortage by allowing one donor cornea to provide treatment for multiple patients.

Frequently Asked Questions

How does HCEC therapy differ from a standard cornea transplant?

Standard transplants like DSAEK involve surgically placing a disc of donor tissue. In contrast, HCEC therapy involves injecting cultured cells directly into the anterior chamber. This minimally invasive method reduces the risk of graft detachment and simplifies the recovery process.

What are the primary risks of cell injection therapy?

Based on recent findings, the most common complication is cystoid macular edema, which is usually manageable with medication. Researchers did not observe major complications like rejection or infection in this small cohort, though long-term data is still being collected.

Can one donor provide cells for multiple patients?

Yes, one of the greatest advantages of this technology is scalability. Culturing cells in a laboratory allows a single donor cornea to produce enough therapeutic doses to treat up to 100 or more patients, potentially ending the donor tissue shortage.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Ogino R et al. Cultured Human Corneal Endothelial Cell Injection for Endothelial Graft Failure After DSAEK. JAMA Ophthalmol. 2026 Apr 16. doi: 10.1001/jamaophthalmol.2026.0812. PMID: 41989809.


2. Kinoshita S, et al. Long-term corneal rejuvenation after transplantation of cultured human corneal endothelial cells. Ophthalmology. 2025. doi: 10.1016/j.ophtha.2025.08.012.


3. Malhotra et al. Cultured human corneal endothelial cell-based therapy for treatment of Fuchs endothelial corneal dystrophy. Ann Eye Sci. 2024;9:24.