Xenographic lenticule implantation followed by riboflavin and UV treatment: A promising alternative for corneal ectasias management

Abstract

The cornea is the primary refracting surface of the eye, requiring precise curvature to ensure optimal vision. Any distortion in its shape may result in significant visual impairment. Corneal ectasias, such as keratoconus (KC), is characterized by gradual thinning and protrusion of the thinned area, due to biomechanical weakening of the tissue, leading to astigmatism and vision loss. KC affects approximately 1 in 2000 individuals globally. While corneal transplantation is the main treatment, limited donor availability and potential immunogenic reactions have spurred the search for alternatives. Stromal lenticule implantation using decellularized porcine corneas offers a promising solution, with reduced immunogenicity and risk of rejection. Additionally, combining this approach with riboflavin and UV radiation treatment post-surgery enhances collagen fibril cross-linking, promoting tissue integration and organization. This study evaluated the efficacy of heterologous transplantation of decellularized porcine lenticules into the corneal stroma of rabbits, followed by riboflavin application and UV radiation. Results demonstrated increased stromal thickness and no signs of tissue rejection, indicating minimal immunogenicity of the lenticules. The cross-linking technique successfully improved tissue organization, suggesting that xenographic lenticule implantation, combined with riboflavin and UV light, is a promising alternative for treating corneal ectasias like KC. Further research is necessary to confirm the long-term efficacy and safety of this method in human subjects.