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Regenerative Surgery of the Corneal Stroma for Advanced Keratoconus

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Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Cellular therapy of the corneal stroma, with either ocular or extraocular stem cells, has been gaining a lot of interest over the last decade. Multiple studies are showing its potential benefits concerning its capacity to alleviate corneal scars, improve corneal transparency, generate new organized collagen within the corneal host stroma, and its immunosuppressive and immunomodulatory properties. Autologous extraocular stem cells do not require a healthy contralateral eye and they do not involve any ophthalmic procedures for their isolation. Mesenchymal stem cells (MSCs) have been the most widely assessed and have a high potential to differentiate into functional adult keratocytes in vivo and in vitro. While embryonic stem cells have been partially abandoned due to ethical issues. The induced pluripotent stem cells have opened a new and very promising field for future research, they are obtained from adult differentiated cells, and possess the capacity to theoretically differentiate into any cell type.

Our group carried out the first clinical trial in this regard in 14 patients with advanced keratoconus. The selected patients were divided into 3 experimental groups. Group-1 (G-1) patients underwent implantation of adipose-derived adult stem cells (ADASCs) alone. Group-2 (G-2) patients received a decellularized human donor corneal stroma lamina (120 μm of thickness). Group-3 (G-3) patients received implantation of an ADASCs-recellularized human corneal stroma lamina. ADASCs were previously obtained by elective liposuction. Implantation was performed into a femtosecond-assisted 9.5-mm diameter lamellar pocket, under topical anesthesia. Follow-up data of 36 months was obtained, with any case showing adverse reactions such as infection, haze, or allogeneic graft rejection.

Advanced stem cell therapy with implantation of autologous ADASCs with or without decellularized human corneal stroma showed good preliminary results for the treatment of advanced keratoconus.

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Author information

Authors and Affiliations

  1. Optica General, Saida, Lebanon

    Mona El Zarif

  2. Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain

    Mona El Zarif

  3. Lebanese University, Doctoral School of Sciences and Technology, Beirut, Lebanon

    Mona El Zarif

  4. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió del Barrio & Jorge L. Alió

Authors
  1. Mona El Zarif
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  2. Jorge L. Alió del Barrio
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  3. Jorge L. Alió
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Correspondence to Jorge L. Alió .

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Editors and Affiliations

  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

Eletronic Supplementary Material

Autologous Adipose Derived Adult Stem Cells (ADASCs) Implantation in Advanced keratoconus (MP4 5737 kb)

Implantation of Descellularized/Recellularized Human Corneal Laminas with (ADASCs) in Advanced keratoconus (MP4 5731 kb)

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El Zarif, M., del Barrio, J.L.A., Alió, J.L. (2023). Regenerative Surgery of the Corneal Stroma for Advanced Keratoconus. In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_24

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  • DOI: https://doi.org/10.1007/978-3-031-32408-6_24

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