Artificial corneas versus donor corneas for repeat corneal transplants

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Biomaterials Science

Background:

• Corneal transplantation, or penetrating keratoplasty (PK), is a common procedure for vision restoration.
• Repeat corneal surgery may be necessary following graft failure, utilizing either donor corneas or artificial keratoprostheses.
• The optimal strategy for repeat corneal transplantation after PK failure remains unclear.

Purpose of the Study:

• To evaluate the effectiveness of artificial corneas compared to donor corneas in patients with one or more prior failed corneal transplantations.
• To identify the most suitable treatment option for individuals requiring repeat corneal surgery.

Main Methods:

• A comprehensive literature search was conducted across multiple databases, including CENTRAL, MEDLINE, EMBASE, LILACS, mRCT, ClinicalTrials.gov, and WHO ICTRP.
• Searches were performed without date or language restrictions.
• Two independent reviewers assessed identified reports for randomized controlled trials (RCTs) or controlled clinical trials (CCTs).

Main Results:

• No RCTs or CCTs were found that directly compared artificial corneas with donor corneas for repeat corneal transplantations.
• Observational cohort studies and non-comparative case series were assessed for discussion purposes only, without data synthesis.

Conclusions:

• The optimal management strategy for patients with failed corneal grafts is currently unknown.
• There is a lack of controlled trials comparing artificial corneal devices (like the Boston type 1 keratoprosthesis) with repeat donor corneal transplantation.
• Further research, particularly well-designed clinical trials, is essential to guide clinical decisions and improve outcomes for patients with corneal opacification.