Gene therapy in corneal diseases]

Gene therapy raised euphoric expectations in the past that have yet to be met and have even been lowered due to the absence of concrete clinical successes and the occurrence of some tragic incidents. In spite of the great future potential of gene therapy, numerous pilot studies in this field will probably be discontinued for a long time. However, despite these failures, diseases will continue to be the aim of gene transfer studies with experimental protocols using only temporary gene expression or those restricted to individual organs and thus requiring only a low dose of the vehicle (vector). The eye is exceptionally well suited as a potential target organ because of its good and selective accessibility, low volume and the resultant low number of gene ferries required as well as its special immunological status. The prognosis of corneal grafting can be improved and profit from the methods catalogue of gene transfer protocols. Moreover, the cornea can be used for ex vivo gene transfer before grafting. Ophthalmology could thus occupy a pioneer position in clinical gene transfer. A survey of the literature describes the current state of experimental improvement in corneal grafting, the effect on scarring, neo-vascularization, and herpetic corneal infection. The essential problem of gene therapy is the unsatisfactory gene transfer technique. Difficulties and current improvements are discussed.