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Endothelial Implantation or Replication….

Which is the future ????

Professor

Mahmoud M. Ismail

Al-Azhar University

More than 120 years ago

• Von Hippel A. Eine Neue

methode der Hornhaut

transplantation. Graefes

Arch Ophthal 1888; 34:108-30

• Zirm E. Eine erfolgreiche

totale keratoplastik. Archiv

Ophthalmol 1906; 64:580-93

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Lamellar

Anterior

Femto Ant. Lamellar KeratoplastyFALK

Deep Ant Lamellar KeratoplastyDALK

Posterior

Descemet’s

Membrane Endoth. KeratoplastyDEMEK

Pre-Descemet’s

Endoth. KeratoplastyPDEK

Penetrating

1ry Graft failure

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ESCRS Milan 2012 we presented:

One Donor = DALK + Tectonic + DMEK

DEMEK / PDEK

• You still need a

corneal graft …!!!

• Training & Surgery

time

• Not free of

complications

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In Vitro “Expansion”

Complete Failure but we

learned :

- Peripheral cells ++++

- Expansion can occur In

NON-inflammatory

• Arrested in G 1 Mitotic

cycle

• Easy Apoptosis

Endothelium is non-regenrative

Endothelial - Mesenchymal

Transition = loss of function

• Change in cell Shape & Mono

layer

• Hyper- motility loss of cell

junction

• = Fibroblastic

phenotype

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1st Endothelium culture

&

Transplant in Human

His Technique … !!!

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Cultured Endothelial Injection

RHO (Rock) Inhibitor

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Can be this the new Frontier ??

Senju

Pharmaceutical

Japan

Amniotic membrane … !!!

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Growth Factors, mRNA

Epidermal growth

factor (EGF)

Transforming growth

factor-α (TGF-α)

Keratinocyte growth

factor (KGF)

Hepatocyte growth

factor (HGF)

Basic fibroblast

growth factor (bFGF)

Transforming growth

factors (TGF)-β1

Transforming growth

factors (TGF)-β2

Transforming growth

factors (TGF)-β3

Amniotic Membrane Eyedrops ... !!!

Advantges

Easy access

Cheap

High Compliance

Disadvantges

Freshly prepared

Stored +6 degrees

Free of Hepatits & AIDs

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To be continued … !!!

3500 years ago

Edfu Temple - Egypt

850 years ago

Cordoba Museum

Al-Andalus SPAIN

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THANK YOU