Posters

Regenerative medicine of the corneal stroma for advanced keratoconus: one year outcomes

Poster Details

First Author: J.Alió del Barrio SPAIN

Co Author(s):    J. Alio   M. El Zarif   M. de Miguel   A. Azaar   N. Makdissy   W. Harb     

Abstract Details

Purpose:

To evaluate the long term safety and efficacy of the cellular therapy of the corneal stroma by the intrastromal implantation of autologous adipose derived adult stem cells (ADASC) with or without sheets of decellularized donor human corneal stroma for patients with advanced keratoconus (stage≥4).

Setting:

Vissum Corporación and Universidad Miguel Hernández, Alicante, Spain. -Optica General, Saida, Lebanon -Reviva Regenerative Medicine Center, Beirut, Lebanon.

Methods:

Fourteen consecutive patients were selected and randomly distributed into 3 experimental groups: 1. Implantation of autologous ADASC alone (3x 106/1mL ) (n:5); 2. Decellularized donor 120 µm thick corneal stroma lamina alone (n:5); 3. Recellularized donor lamina with 1x106 autologous ADASC+ another 1x106/1mL cells at the time of the surgery (n:4). 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. 12 months postop data was collected: visual acuity (VA), refraction, biomicroscopy, corneal topography, corneal optical coherence tomography and corneal confocal biomicroscopy.

Results:

No complications were recorded, and full corneal transparency recovered within 3 months. No patient lost lines of visual acuity. Corrected distance VA improved 0.231, 0.264 and 0.094 Snellen-lines in G1-2-3, respectively. In G1, refractive parameters showed an overall stability, in G2-3 sphere improved 2.35D and 0.625D, respectively. Anterior keratometry remained stable(G1) and improved in G2-3 (mean improvement of 2D). Corneal aberrometry significantly improved. Cornea OCT showed a mean improvement of 14.5µm (G1) and 116.4µm (G2-3) in the central thickness, new collagen production was observed at the surgical plane(G1). Confocal biomicroscopy confirmed the host recellularization of the implanted laminas.

Conclusions:

Cellular therapy of the human corneal stroma with autologous ADASC is safe and moderately effective for advanced keratoconus in the long term. Decellularized donor corneal stroma integrates well with the surrounding host stroma, being efficiently repopulated by host keratocytes. Potential benefits of its preoperative recellularization with autologous ADASC remains unclear.

Financial Disclosure:

None