Post on 22-Aug-2020
transcript
1/29/2018
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Endothelial Implantation or Replication….
Which is the future ????
Professor
Mahmoud M. Ismail
Al-Azhar University
More than 120 years ago
• Von Hippel A. Eine Neue
methode der Hornhaut
transplantation. Graefes
Arch Ophthal 1888; 34:108-30
• Zirm E. Eine erfolgreiche
totale keratoplastik. Archiv
Ophthalmol 1906; 64:580-93
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Lamellar
Anterior
Femto Ant. Lamellar KeratoplastyFALK
Deep Ant Lamellar KeratoplastyDALK
Posterior
Descemet’s
Membrane Endoth. KeratoplastyDEMEK
Pre-Descemet’s
Endoth. KeratoplastyPDEK
Penetrating
1ry Graft failure
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ESCRS Milan 2012 we presented:
One Donor = DALK + Tectonic + DMEK
DEMEK / PDEK
• You still need a
corneal graft …!!!
• Training & Surgery
time
• Not free of
complications
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In Vitro “Expansion”
Complete Failure but we
learned :
- Peripheral cells ++++
- Expansion can occur In
NON-inflammatory
• Arrested in G 1 Mitotic
cycle
• Easy Apoptosis
Endothelium is non-regenrative
Endothelial - Mesenchymal
Transition = loss of function
• Change in cell Shape & Mono
layer
• Hyper- motility loss of cell
junction
• = Fibroblastic
phenotype
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1st Endothelium culture
&
Transplant in Human
His Technique … !!!
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Cultured Endothelial Injection
RHO (Rock) Inhibitor
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Can be this the new Frontier ??
Senju
Pharmaceutical
Japan
Amniotic membrane … !!!
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Growth Factors, mRNA
Epidermal growth
factor (EGF)
Transforming growth
factor-α (TGF-α)
Keratinocyte growth
factor (KGF)
Hepatocyte growth
factor (HGF)
Basic fibroblast
growth factor (bFGF)
Transforming growth
factors (TGF)-β1
Transforming growth
factors (TGF)-β2
Transforming growth
factors (TGF)-β3
Amniotic Membrane Eyedrops ... !!!
Advantges
Easy access
Cheap
High Compliance
Disadvantges
Freshly prepared
Stored +6 degrees
Free of Hepatits & AIDs
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To be continued … !!!
3500 years ago
Edfu Temple - Egypt
850 years ago
Cordoba Museum
Al-Andalus SPAIN
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THANK YOU