Advances in corneal surgery and cell therapy: challenges and perspectives for eye banks

Recent advances in the fields of eye banking, ophthalmology and regenerative medicine are challenging the traditional activities of eye banks. Serum-free media are being evaluated for corneal storage at 30.5–37°C (organ culture) or 2–6°C (cold storage). Autologous serum eye drops and amniotic membrane transplantation are being offered as complementary or alternative remedies for ocular surface disorders. While penetrating keratoplasty remains the most common procedure for cornea transplantation, advances in corneal surgery have led to the development of lamellar keratoplasty as a way to replace only the anterior stroma or the posterior stromal and endothelial layers. Progress in femtosecond lasers and microkeratome-based techniques in creating pre-cut endothelial donor tissues are at the basis of the success of lamellar procedures. Autologous-cultured limbal stem cells have been used to restore damaged corneal surfaces in hundreds of patients with limbal stem cell deficiency. Strategies aimed at the regeneration of conjunctival epithelium and corneal endothelium through cell therapy and genetic engineering of corneal stem cells are also under evaluation. Many of these developments might eventually lead to new therapeutic services and treatments offered by eye banks to patients with ocular surface diseases.