Excimer laser ablation shows promise as an experimental approach to remove diseased tissue from the Descemet membranes of Fuchs’ endothelial corneal dystrophy (FECD) patients, which could allow corneal endothelial cells to migrate easily to the wounded area and help in the healing process, a new study in Acta Ophthalmologica suggests. 

In the investigation, Descemet membranes of FECD patients and the corneal endothelium of normal human corneas were ablated ex vivo using an excimer laser.

The research team from Germany and Australia found guttae and corneal endothelium could be ablated with the laser without total damage to the Descemet membrane or stroma, and nearly complete endothelial wound closure was accomplished after 26 to 38 days in the treated corneas. The study noted that light and electron scanning microscopy showed a layer of flat endothelial cells after the procedure, and cellular markers of neurotransmitter activity could only be observed on the inner side of the Descemet membrane.

While the study pointed to the potential of excimer laser ablations as a graft-less FECD treatment option, they cited several methodological problems that need to be resolved first, in addition to in vivo research.

The laser option could pose some advantages, including the avoidance of a corneal graft in combination with the creation of a wound that does not present bare stroma, a favorable stromal healing response and faster cell migration over an intact basement membrane.

Kassumeh S, Studnitz A, Priglinger SG, et al. Ex vivo excimer laser ablation of cornea guttata and ROCK inhibitor-aided endothelial recolonization of ablated central cornea. Acta Ophthalmol. February 3, 2020. [Epub ahead of print].