The cornea is exquisitely designed to protect the eye while transmitting and focusing incoming light. Precise control of corneal hydration by the endothelial cell layer that lines the inner surface of the cornea is required for optimal transparency, and endothelial dysfunction or damage can result in corneal edema and visual impairment. Advances in corneal transplantation now allow selective replacement of dysfunctional corneal endothelium, providing rapid visual rehabilitation. A series of technique improvements have minimized complications and various adaptations allow use even in eyes with complicated anatomy. While selective endothelial keratoplasty sets a very high standard for safety and efficacy, a shortage of donor corneas in many parts of the world restricts access, prompting a search for alternatives. Clinical trials are underway to evaluate the potential for self-recovery after removal of dysfunctional central endothelium in patients with healthy peripheral endothelium. Various approaches to using cultured human corneal endothelial cells are also in clinical trials; these aim to multiply cells from a single donor cornea for use in potentially hundreds of patients. Pre-clinical studies are underway with induced pluripotent stem cells, endothelial stem cell regeneration, gene therapy, anti-sense oligonucleotides, and various biologic/pharmacologic approaches designed to treat, prevent, or retard corneal endothelial dysfunction. The availability of more therapeutic options will hopefully expand access around the world while also allowing treatment to be more precisely tailored to each individual patient.

角膜经过精心设计，可在传输和聚焦入射光的同时保护眼睛。角膜内表面的内皮细胞层需要精确控制角膜水合作用以获得最佳透明度，而内皮功能障碍或损伤可导致角膜水肿和视力障碍。角膜移植的进展现在允许选择性更换功能失调的角膜内皮，提供快速的视力康复。一系列技术改进使并发症最小化，各种适应甚至允许在具有复杂解剖结构的眼睛中使用。虽然选择性内皮角膜移植术为安全性和有效性设定了非常高的标准，但世界许多地区供体角膜的短缺限制了使用，促使人们寻找替代品。正在进行临床试验，以评估在具有健康外周内皮的患者中去除功能失调的中枢内皮后自我恢复的潜力。使用培养的人角膜内皮细胞的各种方法也在临床试验中；这些旨在从单个供体角膜中繁殖细胞，以供数百名患者使用。目前正在进行诱导多能干细胞、内皮干细胞再生、基因治疗、反义寡核苷酸和各种旨在治疗、预防或延缓角膜内皮功能障碍的生物/药理学方法的临床前研究。更多治疗选择的可用性有望在世界范围内扩大可及性，同时还允许更精确地针对每个患者量身定制治疗。