Table 2 A summary of mechanical approaches to improve corneal stomal thickness
From: New dawn for keratoconus treatment: potential strategies for corneal stromal regeneration
Categories | Therapeutic opportunity | Stage of research | Advantages | Limitations | |
|---|---|---|---|---|---|
Surgical methods | Advanced keratoconus | In clinical applications | Better visual outcomes | Higher rates of graft rejection, suture-related complications, high residual astigmatism; poor long-term graft survival rate | |
Stage II–III | In clinical applications | Reduced rejection and astigmatism | Complexity of operation; risks of suture-related complications | ||
ALK [52] | Advanced keratoconus | In clinical applications | Lower risk of graft rejection; less endothelial cell loss; better graft survival; less intra-/postoperative complications | Suture-induced complications | |
FL-MILK [61] | Stage II-III | In clinical applications | Plentiful source; minimally invasive, more precise and quick recovery | It needs a longer follow-up period to answer the concerns about the maintenance of stabilizing effects | |
Stage I-II | In clinical applications | A safe and minimally invasive extraocular procedure; no interference with later surgical treatment | Ectatic changes; abnormal epithelial cell ingrowth | ||
Advanced keratoconus | In clinical applications | It can postpone or prevent a more invasive corneal surgery, while minimizing the complications and allowing less stringent surveillance and intensive medical therapy | Patients should be counseled to avoid eye-rubbing; allergies may need closer monitoring and treatment; limited increase in corneal thickness; the long-term remissive effect is uncertain | ||
Stage II-III | In clinical applications | It eases the harvesting of the graft; minimally invasive | More cases and longer follow-up are needed for keratoconus treatment | ||
Bioengineered corneal tissues | DPC [64] | – | In clinical applications | Plentiful source; low risk of graft rejection | Conventional suture methods are not applicable; further explorations are needed for keratoconus treatment |
BPCDX [65] | Advanced keratoconus | In clinical trials | Plentiful source; safer, simpler and minimally invasive method | Ethical issues remain to be defined; more clinical testing should be down | |