Cultured Human Corneal Endothelial Cell Injection (Vyznova) in Eyes with Extremely Low Intraocular Pressure After Glaucoma Surgery: Case Reports.
Ogino Rintaro, Shirane Mariko, Ibrahim Osama, Yagi-Yaguchi Yukari, Tomida Daisuke, Yamaguchi Takefumi
AI Summary
Cultured corneal cell injection (Vyznova) effectively treated corneal swelling in two glaucoma patients with extremely low eye pressure, offering a promising alternative to traditional surgery.
Abstract
Purpose
Eyes with extremely low intraocular pressure (IOP) less than 4 mm Hg after glaucoma surgery represent a major challenge for endothelial keratoplasty, as inadequate anterior chamber support often leads to graft detachment and early graft failure. Cultivated human corneal endothelial cell (cHCEC) injection has recently emerged as a graft-free therapeutic alternative; however, its efficacy in eyes with extremely low IOP has not been well established.
Methods
This case series describes the clinical outcomes of cHCEC therapy using Vyznova in 2 patients with bullous keratopathy (BK) and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Results
In case 1, corneal edema resolved rapidly after cHCEC injection, with improvement in best-corrected visual acuity (BCVA) from 20/2000 to 20/30 at 1 month and 20/25 at 3 months. Central corneal thickness (CCT) decreased from 747 μm preoperatively to 517 μm at 3 months. Endothelial cell density (ECD) reached approximately 2600 cells/mm2 at 1 month and was maintained at 3 months. In case 2, corneal clarity was restored early after surgery, and BCVA improved from 20/400 to 20/20 at 1 month, remaining stable at 3 months. CCT decreased from 859 μm to 535 μm. ECD was approximately 1500 cells/mm2 at 1 month and remained stable at 3 months. IOP remained low throughout follow-up in both cases.
Conclusions
These cases highlight that cHCEC therapy may be a safe and effective treatment for BK in eyes with extremely low IOP after glaucoma surgery, representing a promising alternative when conventional endothelial keratoplasty carries a high risk.
Key Concepts6
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) resolved corneal edema rapidly in Case 1, improving best-corrected visual acuity (BCVA) from 20/2000 to 20/30 at 1 month and 20/25 at 3 months, in an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) decreased central corneal thickness (CCT) from 747 m preoperatively to 517 m at 3 months in Case 1, an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) resulted in endothelial cell density (ECD) of approximately 2600 cells/mm2 at 1 month, maintained at 3 months, in Case 1, an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) restored corneal clarity early after surgery and improved best-corrected visual acuity (BCVA) from 20/400 to 20/20 at 1 month, remaining stable at 3 months, in Case 2, an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) decreased central corneal thickness (CCT) from 859 m to 535 m in Case 2, an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
Cultivated human corneal endothelial cell (cHCEC) injection (Vyznova) resulted in endothelial cell density (ECD) of approximately 1500 cells/mm2 at 1 month, remaining stable at 3 months, in Case 2, an eye with bullous keratopathy and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures.
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