Artificial Cornea: Past, Current, and Future Directions

Frontiers in Medicine

Maria Gonzalez¹  Eva Larra¹  Iraida Loinaz²  Laura Sánchez-Abella²  Andrea Haiek²  Damien Dupin²  Elizabeth B. Moloney³  Abhay Pandit³  Thomas Ritter³  Neil Lagali⁴  Aritz Bidaguren⁵  Gráinne Holland⁶ 

[1] AJL Ophthalmic, Alava, Spain;CIDETEC, Basque Research and Technology Alliance, Parque Científico y Tecnológico de Gipuzkoa, Donostia-San Sebastián, Spain;CÚRAM Science Foundation Ireland Research Centre for Medical Devices, National University of Ireland, Galway, Ireland;Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden;Ophthalmology Department, Donostia University Hospital, San Sebastián, Spain;School of Medicine, College of Medicine, Nursing and Health Sciences, Regenerative Medicine Institute, National University of Ireland Galway, Galway, Ireland;

关键词: artificial cornea;    blindness;    biointegration;    Boston type-1 keratoprostheses;    osteo-odonto-keratoprostheses;    AlphaCor™;   

DOI  :  10.3389/fmed.2021.770780

来源: DOAJ

【 摘 要 】

Corneal diseases are a leading cause of blindness with an estimated 10 million patients diagnosed with bilateral corneal blindness worldwide. Corneal transplantation is highly successful in low-risk patients with corneal blindness but often fails those with high-risk indications such as recurrent or chronic inflammatory disorders, history of glaucoma and herpetic infections, and those with neovascularisation of the host bed. Moreover, the need for donor corneas greatly exceeds the supply, especially in disadvantaged countries. Therefore, artificial and bio-mimetic corneas have been investigated for patients with indications that result in keratoplasty failure. Two long-lasting keratoprostheses with different indications, the Boston type-1 keratoprostheses and osteo-odonto-keratoprostheses have been adapted to minimise complications that have arisen over time. However, both utilise either autologous tissue or an allograft cornea to increase biointegration. To step away from the need for donor material, synthetic keratoprostheses with soft skirts have been introduced to increase biointegration between the device and native tissue. The AlphaCor™, a synthetic polymer (PHEMA) hydrogel, addressed certain complications of the previous versions of keratoprostheses but resulted in stromal melting and optic deposition. Efforts are being made towards creating synthetic keratoprostheses that emulate native corneas by the inclusion of biomolecules that support enhanced biointegration of the implant while reducing stromal melting and optic deposition. The field continues to shift towards more advanced bioengineering approaches to form replacement corneas. Certain biomolecules such as collagen are being investigated to create corneal substitutes, which can be used as the basis for bio-inks in 3D corneal bioprinting. Alternatively, decellularised corneas from mammalian sources have shown potential in replicating both the corneal composition and fibril architecture. This review will discuss the limitations of keratoplasty, milestones in the history of artificial corneal development, advancements in current artificial corneas, and future possibilities in this field.

【 授权许可】

Unknown