48 EyeWorld Asia-Pacific | March 2025 ASIA-PACIFIC PERSPECTIVES Jodhbir S MEHTA, MD Professor, Singapore National Eye Centre 11 Third Hospital Avenue, Singapore 168751 jodhbir.s.mehta@singhealth.com.sg The article covers two new corneal cell therapies – corneal endothelial and corneal epithelial surgery. Corneal endothelial surgery has changed significantly over the last decade and a half. We have seen endothelial keratoplasty (EK) become the dominant procedure of choice over full thickness penetrating keratoplasty. More recently we have seen the introduction of endothelial cell therapy as an alternative to EK. The therapy involves the injection of cultured endothelial cells, by a syringe, preceded by recipient endothelial removal. The patient then postures face down for 3 hours. The technology, developed by Prof Kinoshita in Japan, has been further developed and commercialized by Aurion Biotech. The report gives an update on a phase 2 multicenter cell doseranging study, which has completed recruitment, and is undergoing follow up. The results will be discussed with the FDA with respect to future development. It is certainly an exciting prospect, of course the cost of the treatment is unknown, at the moment, and this could significantly affect its widespread use. An alternative approach not using a Rocki is to use magnetic nanoparticles. The cells are injected into the anterior chamber, and a magnetic patch placed over the eye. This technology has been developed by Emmecell. Currently the Phase 2 trial testing three different doses has been completed, data to be released later this year. The main difference between the two techniques is the lack of need to remove recipient endothelial cells in the latter. We have also been working in this area, and have just completed our Phase 1b clinical trial on delivering the cells on a carrier. We currently have IRB approval for cell injection therapy of cultured corneal endothelial cells, and also a novel approach using a non cultured technique. Both of these technologies in this article are exciting, since they are both truly minimally invasive, the key question really for both of them is the descemet membrane. Since Fuchs’ endothelial dystrophy is the leading indication for endothelial transplantation, the lack of removal of the guttae could limit both technologies wrt to recurrence of guttae. However, in Asia there are still many patients with pseudophakic bullous keratopathy, which would certainly benefit from these technologies. Switching to the surface, a recent study on cultivated autologous limbal epithelial cell therapy has been developed in the US. This follows the pioneering work of Prof P Rama almost two decades ago. Although this is an exciting development, the introduction of simple limbal epithelial transplantation (SLET), in many parts of the world have superseded CALEC. Epithelial stem cell work has always struggled due to cost, so it will be interesting to see how this develops in the future. Cultivated allogenic epithelial stem cell reconstruction has been more challenging, but new work using iPSC cells (Prof K Nishida) offers some exciting insights in this arena. Editors’ note: Dr. Jodhbir S Mehta disclosed no relevant financial interests. About the Physicians Albert Jun, MD, PhD | Vernah Scott Moyston Professor and Chair, Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, Virginia | cfj3pj@uvahealth.org Ula Jurkunas, MD | Professor of Ophthalmology, Harvard Medical School, Boston, Massachusetts | ula_jurkunas@meei.harvard.edu Ellen Koo, MD | Associate Professor of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Health System, Miami, Florida | exk126@med.miami.edu W. Barry Lee, MD, FACS | Cornea Fellowship Director, Eye Consultants of Atlanta, Atlanta, Georgia | wblee@mac.com Relevant Disclosures Jun: OcuCell Jurkunas: Ocucell Koo: Emmecell, KOWA Lee: Aurion Biotech Reference 1. Jurkunas UV, et al. Cultivated autologous limbal epithelial cell (CALEC) transplantation: development of manufacturing process and clinical evaluation of feasibility and safety. Sci Adv. 2023;9. This article originally appeared in the December 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. CORNEA
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