Scraping Without Endothelial Keratoplasty: A Pilot Laboratory Investigation of an Innovative Approach to Endothelial Regeneration Therapy.

PURPOSE: The objective of this study was to evaluate the efficacy of scraping without endothelial keratoplasty technique using a novel cell scraper for treating corneal endothelial dysfunction and explore the adjuvant effects of a ROCK inhibitor (ROCKi).

METHODS

Human donor tissues (n = 3) were mounted on an artificial anterior chamber, and one-half of the corneal endothelium was scraped with a novel cell scraper. The tissues were then stained with hematoxylin and eosin (H&E) to assess cell removal. In parallel, central peeling (descemetorhexis) using sharp acute forceps (n = 8) and cell scraping using a novel cell scraper (n = 8) was compared with and without ROCKi to investigate the wound healing response. RT-PCR analysis to assess the endothelial-to-mesenchymal transition using ZEB1 , SNAI1/2 , VIM , and CDH1/2 genes was performed after storage.

RESULTS

An ex vivo surgical setup using an artificial anterior chamber demonstrated the feasibility and efficacy of using the cell scraper. Superior wound healing (88%) was observed in the endothelial cell-scraping group compared with Descemet membrane peeling (22%) at day 16. Application of ROCKi expedited wound healing after endothelial scraping (97%) and peeling (40%) compared with their respective controls at day 16. ROCKi treatment promoted endothelial-to-mesenchymal transition; however, with enhanced wound healing after cell scraping, endothelial cells formed a monolayer on native Descemet membrane compared with the peeling method.

CONCLUSIONS

Scraping without endothelial keratoplasty can be performed effectively using the cell scraper and offers a potential alternative to endothelial keratoplasty, which can be effective in treating bullous keratopathy with healthy peripheral endothelial cells. ROCKi enhances wound healing, supporting further clinical testing and potentially delaying corneal tissue implantation.