title: Alternatives to corneal transplantation for the management of bullous keratopathy.
abstract: OBJECTIVE
  Corneal transplantation remains the gold-standard treatment for bullous keratopathy patients as it provides symptomatic relief and visual rehabilitation. As corneas are not always available for transplant, alternative treatments have to be considered for alleviation of discomfort and pain.
  
  
  RESULTS
  Various treatment options available in such cases include conjunctival flaps, anterior stromal puncture, amniotic membrane transplantation, phototherapeutic keratectomy, bandage contact lenses, and hypertonic saline eye drops. A combination of the above treatments can be employed depending upon the severity of bullous keratopathy and co-existing corneal edema. New potential treatments include collagen cross-linking (CXL), cultured endothelial cell injection, and topical treatment with Rho-associated kinase (ROCK) inhibitor.
  
  
  CONCLUSIONS
  There is a lack of clinical trials comparing the safety and efficacy of the currently available treatment options for the management of bullous keratopathy. The effect of these treatments on subsequent corneal transplant has not been observed. CXL seems to offer short-term benefit for relief of pain. Newer potential treatment modalities such as ROCK inhibitors are claimed to be useful for the reversal of early edema associated with corneal endothelial dysfunction; however, long-term clinical trials are awaited.
authors.affiliation: aDepartment of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR bCentre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Gillian D Ji-Yee
authors.initials: GD
authors.lastname: Siu
authors.forename: Alvin L
authors.initials: AL
authors.lastname: Young
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
mesh_terms: D001768:Blister / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D014792:Visual Acuity / Q000502:physiology