Buchumschlag

Stromal transplantation and corneal-sparing techniques in ectatic diseases

Corneal ectatic and degenerative disorders have traditionally been managed with tissue-replacement strategies such as penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). However, an improved understanding of corneal biomechanics, stromal wound healing, and immune privilege...

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Hauptverfasser: Hayashi, Takahiko (Verfasst von) , Igarashi, Ami (Verfasst von) , Fujiwara, Kyohei (Verfasst von) , Kobashi, Hidenaga (Verfasst von) , Son, Hyeck Soo (Verfasst von) , Kling, Sabine (Verfasst von) , Morishige, Naoyuki (Verfasst von) , Yamagami, Satoru (Verfasst von) , Tran, Khoa D. (Verfasst von) , Moramarco, Antonio (Verfasst von) , Hafezi, Farhad (Verfasst von) , Perk, Fatma Feyza Nur Keskin (Verfasst von) , Kılıç, Aylin (Verfasst von) , Fernández-Vega-Cueto, Luis (Verfasst von) , Madrid-Costa, David (Verfasst von) , Baydoun, Lamis (Verfasst von) , Melles, Gerrit (Verfasst von) , Nubile, Mario (Verfasst von) , Alio Del Barrio, Jorge (Verfasst von) , Romano, Vito (Verfasst von)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2 June 2026
In: Progress in retinal and eye research
Year: 2026, Jahrgang: 113, Pages: 101487$p1-35
ISSN:1873-1635
DOI:10.1016/j.preteyeres.2026.101487
Online-Zugang:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.preteyeres.2026.101487
Volltext
Verfasserangaben:Takahiko Hayashi, Ami Igarashi, Kyohei Fujiwara, Hidenaga Kobashi, Hyeck-Soo Son, Sabine Kling, Naoyuki Morishige, Satoru Yamagami, Khoa D. Tran, Antonio Moramarco, Farhad Hafezi, Fatma Feyza Nur Keskin Perk, Aylin Kılıç, Luis Fernández-Vega-Cueto, David Madrid-Costa, Lamis Baydoun, Gerrit Melles, Mario Nubile, Jorge Alio Del Barrio, Vito Romano
Beschreibung
Zusammenfassung:Corneal ectatic and degenerative disorders have traditionally been managed with tissue-replacement strategies such as penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). However, an improved understanding of corneal biomechanics, stromal wound healing, and immune privilege has driven a paradigm shift toward tissue-sparing and layer-selective interventions. In particular, biologically integrated stromal procedures, including Bowman layer transplantation (BLT), corneal allogenic intrastromal ring segments (CAIRS), and stromal lenticule addition keratoplasty (SLAK), aim to restore structural integrity, improve corneal shape, and preserve native tissue while minimising the risks associated with full-thickness transplantation. In this review, we summarise the structural basis of corneal biomechanics, the pathological mechanisms of stromal failure in keratoconus and related disorders, and the biological responses that follow stromal interventions. We then evaluate current evidence on corneal cross-linking (CXL), stromal reinforcement, and stromal addition procedures, with emphasis on indications, mechanisms, clinical outcomes, and limitations. Reflecting this evolution, we frame these procedures as the restoration of specific biomechanical and optical functions rather than mere tissue replacement, aligning corneal surgery with the broader trend toward selective tissue restoration and minimally invasive biological augmentation. To support clinical decision-making, we propose a three-tier Stabilise-Reshape-Replace (SRR) framework. Each tier addresses a dominant clinical problem: SRR is intended as a pragmatic expert-derived scaffold rather than a validated treatment algorithm.
Beschreibung:Gesehen am 17.09.2026
Beschreibung:Online Resource
ISSN:1873-1635
DOI:10.1016/j.preteyeres.2026.101487

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