Tissue engineered endothelial keratoplasty in rabbit: tips and tricks

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Biomaterials Science

Background:

• Corneal endothelial dysfunction is a leading cause of blindness.
• Tissue engineered endothelial keratoplasty (TEEK) offers a promising alternative to traditional corneal transplantation.
• Developing suitable carriers for TEEK is crucial for successful transplantation.

Purpose of the Study:

• To detail the surgical procedure for TEEK in a rabbit model.
• To evaluate the postoperative outcomes of TEEK using different carriers.
• To establish a reliable preclinical model for TEEK research.

Main Methods:

• TEEKs were created using human or rabbit corneal endothelial cells seeded on femtosecond laser-cut ultrathin human stromal lamellae (fs-UTSL) or human anterior lens capsule (fs-HALC).
• Thirty transplantations were performed on aphakic rabbit eyes, with recombinant tissue plasminogen activator (rTPA) used during surgery.
• Native endothelium removal involved scraping and central descemetorhexis, followed by TEEK transplantation mimicking human Descemet's membrane endothelial keratoplasty.

Main Results:

• Controls showed persistent edema; no intraoperative fibrin was observed.
• TEEKs using fs-HALC (9/16) demonstrated better clearing than fs-UTSL (1/6), though not statistically significant (p=0.161).
• Successful TEEKs showed normal human endothelium formation and cell migration by 3-4 weeks; failures were attributed to surgical complications or immune rejection.

Conclusions:

• The established TEEK procedure in rabbits, utilizing rTPA, provides a reliable preclinical model despite surgical complexities.
• Femtosecond laser-cut human anterior lens capsule (fs-HALC) shows potential as a carrier for TEEK.
• Further research is warranted to optimize TEEK for clinical application.