A Modified Long Corneal Tunnel Technique for Intracameral Injection in Cultured Human Corneal Endothelial Cell...

To describe a modified long corneal tunnel technique and report preliminary observations regarding wound sealing during cultured human corneal endothelial cell (cHCEC; Vyznova) injection therapy in a small consecutive case series.

Ten consecutive eyes with bullous keratopathy underwent cHCEC injection by a single experienced surgeon using a long, tangential corneal tunnel created with a 26-gauge needle. Tunnel dimensions and injection parameters were measured retrospectively from surgical video recordings. Wound integrity was assessed intraoperatively using a dry microsponge to detect macroscopically visible fluid egress. Early postoperative anterior segment OCT (CASIA2) parameters-keratometric cylinder (ΔCyl) and endothelial anterior chamber depth (ΔACD)-were also evaluated.

All eyes demonstrated macroscopically leak-free wound closure without sutures. The mean tunnel length was 4.2 ± 0.6 mm, tunnel creation time 14.9 ± 6.3 seconds, and injection time 17.2 ± 7.1 seconds. No intraoperative complications such as hypotony, wound leak, or anterior chamber collapse were observed. Postoperative fluorescein Seidel testing on day 1 confirmed absence of wound leakage in all eyes. Early postoperative OCT measurements showed no clinically meaningful change in keratometric astigmatism (ΔCyl = 0.20 ± 0.53 D), whereas endothelial ACD increased slightly (ΔACD = 0.18 ± 0.17 mm), with no eyes exhibiting anterior chamber shallowing.

This preliminary single-surgeon case series suggests that the long corneal tunnel technique may facilitate macroscopically leak-free wound closure during cHCEC injection. Although encouraging, these findings are limited by subjective leak assessment and small sample size. Larger multicenter studies incorporating objective leak quantification are required to determine reproducibility and comparative performance.