Cultured Human Corneal Endothelial Cell Injection (Vyznova) in Eyes with Extremely Low Intraocular Pressure After Glaucoma Surgery: Case Reports

PURPOSE: Eyes with extremely low intraocular pressure (IOP) less than 4 mm Hg after glaucoma surgery represent a major challenge for endothelial keratoplasty, as inadequate anterior chamber support often leads to graft detachment and early graft failure. Cultivated human corneal endothelial cell (cHCEC) injection has recently emerged as a graft-free therapeutic alternative; however, its efficacy in eyes with extremely low IOP has not been well established. METHODS: This case series describes the clinical outcomes of cHCEC therapy using Vyznova in 2 patients with bullous keratopathy (BK) and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures. RESULTS: In case 1, corneal edema resolved rapidly after cHCEC injection, with improvement in best-corrected visual acuity (BCVA) from 20/2000 to 20/30 at 1 month and 20/25 at 3 months. Central corneal thickness (CCT) decreased from 747 μm preoperatively to 517 μm at 3 months. Endothelial cell density (ECD) reached approximately 2600 cells/mm 2 at 1 month and was maintained at 3 months. In case 2, corneal clarity was restored early after surgery, and BCVA improved from 20/400 to 20/20 at 1 month, remaining stable at 3 months. CCT decreased from 859 μm to 535 μm. ECD was approximately 1500 cells/mm 2 at 1 month and remained stable at 3 months. IOP remained low throughout follow-up in both cases. CONCLUSIONS: These cases highlight that cHCEC therapy may be a safe and effective treatment for BK in eyes with extremely low IOP after glaucoma surgery, representing a promising alternative when conventional endothelial keratoplasty carries a high risk.