Improvement Of Corneal Stromal Opacities In A Keratoconus Patient After Autologous Adipose-Derived Mesenchymal Stem Cell Transplantation
Published 2024 - 42nd Congress of the ESCRS
Reference: PO111 | Type: Case Report | DOI: 10.82333/ce4e-4295
Authors: Daniel Gómez Plaza* 1 , Jorge Alió 2 , Alberto Parafita 3 , Jorge Alió del Barrio 2
1Cornea, Cataract and Refractive Surgery Unit,Vissum (Miranza Group),Alicante,Spain;Ophthalmology Department,Instituto de Microcirugía Ocular (Miranza Group),Barcelona,Spain, 2Cornea, Cataract and Refractive Surgery Unit,Vissum (Miranza Group),Alicante,Spain;Division of Ophthalmology,Universidad Miguel Hernández,Alicante,Spain, 3Ophthalmology Department,Complexo Hospitalario Universitario de Pontevedra,Pontevedra,Spain;Clínica Oftalmológica Dr Parafita,Ribeira ,Spain
Purpose
The corneal stroma constitutes approximately 90% of the total corneal thickness and is susceptible to various diseases such as corneal dystrophies, scars, or ectatic disorders like keratoconus. In recent years, new techniques utilizing mesenchymal stem cells have emerged to restore the anatomy and physiology of the cornea. One such therapy, autologous adipose-derived adult stem cell (ADASC) injection into a laser stromal pocket, has shown safety in phase 1 trials.
The purpose is to describe the progression and changes in corneal opacities after ADASC injection into a stromal pocket in a keratoconus patient over one year of follow-up. We aim to delineate the evolution of the corneal opacities measured by density in grayscale units (GSU).
Setting
Case report at Vissum (Miranza Group) Alicante
Report of case
A 39-year-old female with grade 4 keratoconus in the right eye exhibited unaided distance visual acuity (UDVA) of 0.15 and corrected distance visual acuity (CDVA) of 0.36. Slit lamp show diffuse central and paracentral stromal corneal opacities, confirmed by anterior segment OCT (AS-OCT) MS-39 (CSO, Italy). Topography values indicated a K max of 60, corneal astigmatism of 5 DP, and RMS coma of 0.96 µm.
3x106 ADASC were injected into a 9.5 mm diameter lamellar pocket created by femtosecond laser at half the depth of the preoperative thinnest pachymetry point measured by AS-OCT. Detailed laser parameters and ADASC preparation can be found in previous publications.
Corneal stromal transparency was evaluated for optical density (OD) using AS-OCT horizontal images. The Image J.JS program (National Institutes of Health) was used. A 7mm central area, excluding Bowman's and Descemet's layers, was divided into anterior (containing the stromal pocket) and posterior halves. OD was measured in three sections: G1 anterior, G2 posterior, and G3 total. Subsequently, the OD progression of the three areas was determined in GSU (0 for total white, 255 for total black).
Before the procedure, GSU measurements were: G1 55.9, G2 46.8, and G3 51.5. Corneal transparency was achieved at the first month, persisting until the last visit. After one year, UDVA was 0.15, CDVA was 0.36, topography values remained unchanged, GSU measurements were: G1 42.7, G2 39.6, and G3 41.2. No complications were observed.
Conclusion/Take home message
In summary, direct injection of ADASC into a stromal pocket may offer a promising therapeutic approach for corneal opacifications. Mesenchymal stem cells may enhance corneal remodeling and collagen turnover, potentially improving established corneal scars. The mechanism remains unclear, but it is likely mediated by paracrine secretions through extracellular vesicles that stimulate keratocyte population turnover. Specific studies aiming to investigate this outcome in various types of corneal opacifications and scars are necessary to determine the success of these observations.