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Updated: Jun 5, 2026
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Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
Stromal Transplantation and corneal-sparing techniques in ectatic diseases
Takahiko Hayashi1, Ami Igarashi1, Kyohei Fujiwara1
1Department of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan.
Progress in Retinal and Eye Research
|June 3, 2026
Summary
Corneal ectatic disorders are shifting from tissue replacement to tissue-sparing procedures like Bowman layer transplantation. These interventions restore corneal structure and shape, minimizing risks associated with full-thickness transplants.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Biomaterials Science
Background:
- Corneal ectatic and degenerative disorders traditionally treated with penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK).
- Advancements in corneal biomechanics, stromal wound healing, and immune privilege have spurred a shift towards tissue-sparing, layer-selective interventions.
- Newer procedures like Bowman layer transplantation (BLT), corneal allogenic intrastromal ring segments (CAIRS), and stromal lenticule addition keratoplasty (SLAK) aim to preserve native tissue while restoring structural integrity and corneal shape.
Purpose of the Study:
- To review the structural basis of corneal biomechanics and pathological mechanisms of stromal failure in keratoconus and related disorders.
- To evaluate current evidence on corneal cross-linking (CXL), stromal reinforcement, and stromal addition procedures, focusing on indications, mechanisms, clinical outcomes, and limitations.
- To propose a three-tier Stabilise-Reshape-Replace (SRR) framework to guide clinical decision-making for corneal ectatic disorders.
Main Methods:
- Literature review of corneal biomechanics, stromal wound healing, and immune privilege.
- Evaluation of evidence for corneal cross-linking (CXL), stromal reinforcement, and stromal addition procedures.
- Development of a conceptual framework (SRR) for clinical decision-making.
Main Results:
- Biologically integrated stromal procedures offer alternatives to full-thickness transplantation, minimizing risks.
- These procedures aim to restore structural integrity, improve corneal shape, and preserve native tissue.
- The proposed SRR framework categorizes interventions based on clinical goals: Stabilize, Reshape, and Replace.
Conclusions:
- Corneal surgery is evolving towards selective tissue restoration and minimally invasive biological augmentation.
- Tissue-sparing stromal procedures represent a paradigm shift in managing corneal ectatic disorders.
- The SRR framework provides a pragmatic scaffold for clinical decision-making, though it requires further validation.
