Artificial and Bioengineered Therapeutic Options for Corneal Endothelial Disease

Background: Corneal endothelial dysfunction continues to be a primary indication for corneal transplantation globally. Due to ongoing constraints in donor tissue availability and graft durability, artificial graft technologies are increasingly recognized as viable alternatives, particularly for eyes unsuitable for conventional allogeneic transplantation. Aim: This article examines the contemporary state of artificial corneal endothelial grafts, emphasizing technological advancements, incorporation into surgical procedures, and their developing function in meeting the unfulfilled requirements of endothelial keratoplasty. Methods: A comprehensive synthesis of recent preclinical and clinical literature was performed, concentrating on scaffold-based constructs, cell-seeded and acellular methodologies, biomaterial characteristics, and innovative surgical delivery techniques. The review highlights translational pathways and contrasts the initial outcomes of artificial and donor-derived endothelial grafts. Results: Advancements in regenerative biomaterials and cell culture systems have resulted in the development of functional endothelial substitutes. Engineered grafts, comprising decellularized stromal carriers, synthetic polymer matrices, and human cell-laden constructs, have demonstrated promising biocompatibility and functional results in preliminary trials. The integration of these constructs into methods akin to Descemet membrane endothelial keratoplasty (DMEK) has improved clinical viability, diminished immunologic risk, and shown potential for visual recovery. Conclusions: Artificial endothelial grafts signify a revolutionary advancement in corneal surgery, addressing donor shortages and expanding the applications of endothelial keratoplasty. Although additional clinical validation and regulatory processes are required, existing evidence indicates that these technologies may soon transform treatment protocols for corneal endothelial disease.