Updates on Therapy for Cornea Edema

Cornea edema may result from a number of conditions that disrupt the endothelial cell layer including dystrophies, uveitis, surgical manipulation, toxicity, trauma, and elevated intraocular pressure among other known causes. Given the exquisite link of healthy endothelial cell function with physiologic cornea clarity, efforts in the past to resolve cornea edema have revolved around direct replacement of these cells. Prior to the advent of partial thickness corneal transplants, penetrating keratoplasty (PKP) provided the most direct means for replacing Descemet’s membrane and the endothelium. Of course, this approach not only replaced these layers, but also the stroma, Bowman’s layer, and the epithelium. Although a necessary approach for cornea edema where significant stromal scarring has occurred, PKP maintains the highest risk of endothelial rejection and graft failure among corneal allograft transplants [1, 2] with longer times to recovery of functional vision [3] and higher incidences of microbial keratitis [3–5].