Understanding the complexity of the corneal endothelium for regenerative medicine

Endothelial keratoplasty is the current therapy for corneal endothelial disease. Advances in surgical procedures are improving reproducibility and accessibility to corneal transplantation, causing an increase in the number of corneal transplantations globally. Unfortunately, there is currently a worldwide donor cornea shortage, aggravated by the increasing number of transplantations. It has been estimated that only one out of seventy patients in need has access to a donor cornea, and 12.7 million people in the world are awaiting treatment. The development of regenerative medicine approaches to treat corneal endothelial disease is necessary to tackle the increasing demand for donor corneal tissue and to provide treatment to those in need. The work described in this thesis addresses this need, with our main goal to contribute to the development of such innovative therapies. We review the current and developing approaches for the regeneration of the corneal endothelium, presenting its pros and cons, but also providing a social perspective and a regulatory guide for the approval of such treatments in the European Union. We show experimentally that corneal endothelial tissue could be delivered to the operation theater preloaded in an injection cannula, without affecting its quality.