Eyeworld

78 | EYEWORLD | APRIL 2023 C ORNEA Relevant disclosures Chamberlain: ASLAN Pharmaceuticals, Cambium, Kowa Pharmaceuticals, LEO Pharma, Noveome Biothera- peutics, Oyster Point Pharma, Regeneron, Trefoil Therapeutics Chan: Aurion Biotech Venkateswaran: CorneaGen Contact Chamberlain: chamberw@ohsu.edu Chan: clarachanmd@gmail.com Venkateswaran: nandini. venkat89@gmail.com Dr. Chamberlain said the currently enrolling DETECT multicenter, randomized, controlled tri- al will provide high-level evidence as to whether DMEK will outperform DSAEK in complex eyes. "Important outcomes of this trial will be en- dothelial cell loss and graft survival at 6 months and 2 years," he said. "An intriguing arm of the trial will include supplementing a randomized cohort of the patients with postoperative topical ripasudil, a rho-kinase (ROCK) inhibitor, which may promote faster corneal clearing or even longer graft survival by reducing endothelial cell stress." If this trial shows that DMEK outperforms DSAEK in even complex eyes, Dr. Chamber- lain said we'll see an even broader adoption of DMEK. While DMEK is on the rise and surgeons are becoming adept at it, like the full thickness transplants and other lamellar keratoplasty techniques that came before it, someday DMEK might even become antiquated. "Endothelial cell cultures are being devel- oped by several entities (Aurion Biotech and Emmecell) and are now in clinical trials and may supplant some of these surgeries, if results look promising," Dr. Chamberlain said. "Addi- tionally, rho-kinase inhibitors and recombinant bioengineered fibroblast growth factor may be pharmaceutical agents that promote endothelial cell migration and proliferation that could be exploited to clear corneas with Fuchs dystrophy without transplanting allogeneic cells at all. These agents are in various stages of clinical trials." "If our technologies with endothelial cells start to gain traction, we may someday see the disappearance of all endothelial keratoplasty," Dr. Venkateswaran said. "Many surgeons taught themselves DSAEK because the technique didn't exist during their training; they then taught themselves DMEK. Our therapeutics are con- stantly advancing. Young ophthalmologists are fortunate because they currently learn DSAEK and DMEK in training. … However, what we are being trained in may grow extinct in the future." continued from page 77 DMEK tissue with gas bubble with two S stamps Source: Nandini Venkateswaran, MD Unfurling of DMEK graft Source: Nandini Venkateswaran, MD

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