Corneal Artificial Endothelial Layer (EndoArt) in Outpatients: Outcomes From a Case Series

The aim of this study was to describe the surgical approach and outcomes of artificial endothelial layer (EndoArt) implantation in chronic corneal edema.

Fifteen eyes of 15 patients with chronic corneal edema were implanted with an artificial endothelial keratoprosthesis (EndoArt, EyeYon Medical, Israel) several months (range: 2-108 months; mean: 42.7 ± 38.5 months) after at least one Descemet membrane endothelial keratoplasty failure or as a first-line procedure to improve anterior segment visibility ahead of a second procedure (phaco + Descemet membrane endothelial keratoplasty) in outpatient procedures. A 20% SF 6 -air mixture was used as a tamponade to secure the EndoArt in place. The number of transfixing sutures (1-4) was based on surgeon judgment and preference, considering patient-specific anatomical factors such as aphakia or previous graft configuration. The original technique used only 1 suture. Measured outcomes included changes in central corneal thickness, best corrected visual acuity (logMAR), rebubbling rate, and postoperative complications.

The preoperative mean central corneal thickness (844 ± 236 µm) decreased significantly postoperatively in all patients (607 μm ± 251 μm at the last visit (1 to 6 months), reduction of 28%, P -value <0.05). Ten eyes (66.7%) required at least 1 rebubbling. Three eyes required more than 2 rebubblings. Eighty percent of patients (12/15) were pseudophakic at the time of surgery.The mean best corrected visual acuity improved significantly from 2.13 ± 0.19 logMAR preoperatively to 1.84 ± 0.53 logMAR at the final follow-up ( P -value <0.05). Postoperative complications included intraocular pressure elevation (33%), partial implant detachment (66.7%), 1 intraoperative posterior dislocation, and 1 case of retinal detachment.

EndoArt may represent a therapeutic option for chronic corneal edema in complex cases where conventional endothelial keratoplasty has failed or carries a high risk of failure. It improves visual acuity and significantly reduces corneal thickness within 3 to 6 months of surgery.