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ABSTRACT
Corneal endothelial decompensation is a condition caused by a decline in corneal endothelial cells (CECs) density below a critical threshold, leading to corneal edema, clouding, and impaired vision.CECs have minimal regenerative capacity in the human body and gradually decrease in number with age.When affected by pathological factors such as inflammation, trauma or infection, irreversible damage can occur.Traditional treatments include penetrating keratoplasty and posterior lamellar endothelial keratoplasty.However, their application in clinical practice is limited due to problems such as donor shortage, postoperative complications and technical challenge.In recent years, with advances in the understanding of CECs biology and corneal transplantation techniques, emerging approaches such as cell therapy (including cell injection and tissue-engineered endothelial grafts), pharmacological interventions (such as ROCK inhibitors and anti-oxidative stress drugs), and gene therapy (such as CRISPR/Cas9 and RNA interference) have been developed.This review summarizes both traditional and emerging treatments for corneal endothelial decompensation, comparing their advantages and limitations in terms of surgical method, cell source, pharmatheutical therapy, and gene-targeting strategy, and discusses future development trends to provide theoretical support for clinical treatment and research.