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George I. Agorogiannis, George D. Kymionis, Vassilia-Ismini Alexaki, Ourania Castana, Elias Castanas, Ioannis Pallikaris; Topical Application Of Autologous Adipose-Derived Mesenchymal Stem Cells (Mscs) For Persistent Sterile Corneal Epithelial Defect. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5139.
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To report a patient with post-traumatic persistent sterile corneal epithelial defect treated with topical application of autologous adipose-derived mesenchymal stem cells (MSCs).
A 35-yr-old man was referred to the emergency ophthalmology department for treatment of post-traumatic persistent corneal epithelial defect previously treated as infection. One year before, corneal cross-linking was performed for keratoconus stabilization. Slit lamp examination showed a central corneal epithelial defect with underlying stromal opacification, severe corneal thinning and mild conjunctival inflammation. Corneal sensitivity was significantly decreased (measured with a tip of a cotton swap), while corneal scrapings cultures were negative for bacterial, fungal or herpetic infection. Despite conventional medical treatment (patching, unpreserved artificial tears, soft contact lens, and autologous serum eye drops) no corneal epithelial healing progression occurred 50 days after the injury. A penetrating keratoplasty was scheduled since there was a risk of corneal perforation. In the meantime and as we were waiting for a corneal graft, we proposed to the patient the alternative treatment with topical application of autologous adipose-derived MSCs. Institutional Review Board (IRB) was obtained and approved from the University Hospital of Crete.
Corneal epithelial healing progression was started ten days after topical application of autologous adipose-derived mesenchymal stem cells (MSCs) isolated the same day through a limited liposuction. One month later, a complete corneal epithelial healing was observed. Six month later, the corneal epithelium remained intact with mild anterior stromal opacification. No side effects or complications were observed during this follow up period. The patient’s current uncorrected visual acuity lies between 6-7/10.
Topical application of autologous adipose-derived MSCs seems to promote corneal epithelial healing in a patient with persistent sterile corneal epithelial defect refractory to other treatment modalities. Differentiation or trans-differentiation of MSCs into corneal epithelial/stromal cells and/or production of trophic factors could be possible mechanisms behind the corneal healing process.
Clinical Trial: :
IRB University Hospital of Heraklion, Crete, Greece, 13313
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