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Jorge Luis Alio del Barrio, Jorge Alio, Mona El Zarif, Maria de Miguel, Charbel Khalil, Norman Makdissi, Walid Harb; Cellular Therapy with Human Autologous Adipose-derived Adult Stem Cells for Advanced Keratoconus. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5564.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the in vivo safety and efficacy of grafts composed of sheets of decellularized human corneal stroma with or without the recellularization of autologous adipose derived adult stem cells (ADASC) within the corneal stroma of patients with advanced keratoconus
Fourteen consecutive patients were selected and randomly distributed into 3 experimental groups: 1. Implantation of autologous ADASC alone (3x 106/1mL); 2. Decellularized donor 120 µm thick corneal stromal lamina alone; 3. Recellularized donor lamina with 1x106 autologous ADASC+ another 1x106/1mLcells at the time of the surgery. Autologous ADASC were obtained by elective liposuction. Implantation was performed into the corneal stroma through a femtosecond-assisted 9.5mm diameter lamellar dissection under topical anesthesia. Patients were reviewed at 1 day, 1 week, 1, 3 and 6 months postop. Visual function, manifest refraction, slit lamp biomicroscopy, intraocular pressure (IOP), endothelial cell density (ECD), corneal topography, corneal optical coherence tomography (OCT) and corneal confocal biomicroscopy were recorded
No intra or postoperative complications were recorded, with a full corneal transparency recovery in all patients. All patients improved their visual function (complete clinical data with full follow up to be shown). Manifest refraction and topographic keratometry remained stable in group 1 and improved in groups 2 and 3 (mean improvement of 2D in mean keratometry). Cornea OCT showed a mean improvement of 16.5µm (group 1) and 123 µm (groups 2-3) in the central corneal thickness, and new collagen production was observed as patched hyperreflective areas at the level of the stromal pocket (group 1). Confocal biomicroscopy confirmed the survival of the implanted stem cells at the surgical plane (groups 1 and 3)
Cellular therapy of the human corneal stroma in vivo with autologous ADASC is safe. Stem cells survive in vivo with intrastromal new collagen production.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Autologous ADASC (group 1) before (A, x10) and after transplantation (B, confocal microscopy 1 month postop). Slit lamp pictures preop (C) and 6 months (D) after transplant. Cornea OCT image (D) 6 months postop
Decellularized lamina (group 2): slit lamp pictures preop (A), 1 day (B) and 3 months (C) after transplant. Cornea OCT image (D) and keratometric with pachymetric change (E) 3 months postop
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