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First Author: E.Kasparova RUSSIA
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The results of long-turm elaboration, studies and clinical application of the author`s method of Personalized Cell-based Therapy (PCT) for the treatment of early (i.e. developed in the first 1-3 months after surgery) postoperative bullous kerathopathy (PBK) is presented.
ARCADY A. KASPAROV, Prof., EVGENIYA A. KASPAROVA PhD, ALEXANDR S. PAVLUK PhD, LYDIA L. FADEEVA Prof., ANASTASIA M. SOUBBOT PhD, NATALIA V. BORODINA PhD. INSTITUTION OF RUSSIAN ACADEMY OF MEDICAL SCIENCES INSTITUTE of EYE DISEASES RAMS, IVANOVSKY INSTITUTE of VIROLOGY RAMS
The intrakameral PCT method consists of introduction into the anterior chamber of the patient"s eye cell preparation - in vitro-activated by poliA:poliU autologous leukocytes in the processed serum. Face-down position, which the patients take immediately after PCT, allows the deposition of activated cell elements on the back surface of the cornea and thus contributes to a direct contact with the zone of affected endothelial cells and Descemet"s membrane (contact stimulation). In addition to the contact interaction, repeated sessions of PCT provides the circulation in the anterior chamber, which are dissolved in autologous serum cytokines, including growth factors (trophic component). Sessions of PCT were conducted from 1 to 5 times, depending on the clinical dynamics, 3-5 days apart. A total of 117 PCT sessions were held.
Fundamental aspects of the study were detailed characterization of cell preparation, as well as the study of the possible mechanisms of its action. It was found that the cellular composition of the preparation is presented by major leukocyte populations. The content of cytokines and growth factors in the cell preparation has been measured. We suggest that the clinical efficacy of the method is determined to the ability to have an impact on the regeneration of the damaged coneal endothelium. Clinical studies conducted on a large group of 52patients with early PBC showed that pronounced effect - (smoothing of 70% of Descemet"s membrane folds, full corneal edema resorption, transparency rise, corneal thickness reduction and visual acuity increase from 0,1+0,12 up to 0,49 ±0,27) was achieved after applying the PCT in 44.2% of cases; partial effect was observed in 21.1%; the lack of the effect - in 34.6%. Many endothelial cells, visualized with confocal microscopy after PCT in patients with pronounced and partial effect were polyploid (2 nucleus and more). This fact suggests that the application of PCT, probably implemented the regenerative processes in endothelium, including incomplete mitosis and, possibly, division of endothelial cells.
PCT effects begin to appear in the first days after the procedure and, as a rule, maximally develops after 1-3.5 months after its conduction. Personalized cell therapy using autologous cell products, opens the new possibilities for effective treatment of early PBC, which developes in the first months following microsurgery. The designed method of PBC, which allows to obtain from a small amount of the patient"s peripheral blood cell preparation, has been successfully clinically tested and testified about the therapeutic efficacy and safety in the ophthalmic practice. PCT is currently the only effective method of therapeutic influence on the damaged endothelium cells in patients with early postoperative bullous keratopathy, which does not require corneal transplantation.