Corneal Endothelium Single layer of cells on the inner surface. Specialized, flattened, mitochondria-rich cells. Governs fluid and solute transport. Maintains the cornea in the slightly dehydrated state-Optimal optical transparency.

Fuch’s Dystrophy There is a decrease in the # of endothelial cells. Endothelial cells become more irregular. Cells secrete collagen towards Descemet’s causing multilamination. This breaks down the barrier function and results in stromal and epithelial edema.

Normal Endothelial Mosaic Bernard Shain (Patient 2). 1 Year. Normal Endothelial Mosaic 4

Fuch’s Dystrophy Endothelial Cell Count: 545 cells/mm BS – Pre-Op Fuch’s Dystrophy Endothelial Cell Count: 545 cells/mm

Stages of Fuch’s Dystrophy Healthy endo: Cornea Thin and clear Endo dropout: Cornea swells, mild vision loss Severe swelling, blisters on surface, Va drops, pain Chronic swelling, surface scarring Stages of Fuch’s Dystrophy

Fuch’s: Bullous Keratopathy

Treatment in early stages: Goal of improving comfort and function. Hyperosmotics at bedtime (e.g. muro 128 ointment) may help reduce epithelial corneal edema in the morning. Bandage CL can be used in the presence of bullous keratopathy. When visual function deteriorates: Penetrating keratoplasty (PK). DLEK surgery (deep lamellar endothelial keratoplasty). DSAEK (Descemet Stripping Automated Endothelial Keratoplasty). DMEK (Descemet Membrane Endothelial Keratoplasty). Fuch’s is leading reason for PK’s in developed countries.

DLEK Surgery: Split Thickness Surgery to replace only the diseased tissue Recipient tissue removed Scleral incision, deep corneal pocket, and endothelium trephined with Terry Trephine or cut with Cindy Scissors Just endothelium on posterior stromal disc removed from pocket Figure 1: Schematic of DLEK surgery Donor tissue placed into recipient Endothelium replaced with no sutures, supported by air bubble in anterior chamber. Surface remains smooth with no astigmatism 9

IBEST/OUHSC Project Our team seeks to develop a novel 3D bio-printing method to create the first human corneal endothelium tissue. - Bioprinting unprecedented possibilities: - Eliminate the rejection risk and dramatically reduce graft failure rates. - Require less post-operative management and lessen healthcare costs. - Autologous transplantation furthermore decreases the need for donated tissue that is scarce in most areas of the world. Our team: - Dr. Detamore, a biomedical engineer with expertise in biomaterials and regenerative medicine. - Dr. Frank, an ophthalmologist who regularly treats patients with corneal diseases, including corneal endothelial dystrophies.

CELLINK Inkredible 3D Bioprinter