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Evolution of keratocytes density in a corneal regeneration model of advanced keratoconus therapy: a corneal confocal microscopy study

Poster Details

First Author: M.El Zarif LEBANON

Co Author(s):    J. Alio                    

Abstract Details


Managing Keratoconus is performed by following different surgical approaches, recently we described a new surgical approach based on advanced regenerative therapy, using autologous mesenchymal stem cells (ADAS) and descellularized corneal tissue into the human cornea affected by advanced keratoconus. We report herein the corneal confocal microscopy evolution in vivo of the normal cellularity and distribution of the corneal keratocytes following the implantation of ADASc alone or using a decellularized lamina as a carrier, along one year of follow-up, as well to evaluate the presence of a fibrotic tissue and the association between the degree of fibrosis and recellularization.


Division of Ophthalmology, Miguel Hernandez University, Alicante-Spain, Vissum Innovation, Alicante-Spain and Optica General, Saida-Lebanon.


Confocal microscopy study was performed in an interventional prospective, consecutive, randomized, comparative series of cases. A total of 14 keratoconic patients were randomly distributed into 3 groups and were the subject of 3 types of surgical intervention: Group 1: Autologous ADASc implantation (5 patients), Group 2: Decellularized human corneal stroma (5 patients), Group 3: Autologous ADASc + Decellularized human corneal stroma (4 patients). A novel method of quantitative cell counting nuclei was used to evaluate the evolution of cell density. As well the evolution of the morphological implanted cells, the decellularized and recellularized laminas along one year follow up.


A significant increase (P value <0.001) was observed in the cell density in the anterior and posterior corneal stroma with all the groups one year postoperative, comparing to the preoperative values, we obtained same result at the mid stroma in G-1, the anterior, posterior surfaces and within the laminas in G-2 and G-3. Also results at the anterior surface and within the laminas was statistically significantly higher (p= 0,011), as well at the posterior surface (p= 0,029) than those implanted with descellularized laminas. We did not find a direct and significant association between recellularization and the presence of fibrotic tissue.


confocal corneal microscopy shows to be an essential tool in the assessment and “in vivo” follow-up of the corneas implanted with mesenchymal cells for corneal regeneration purposes. Using corneal confocal microscopy, we were able to observe a significant increase in cell density up to one postoperative year at the corneal stroma following the implantation of ADASc alone and in those cases implanted with decellularized and recellularized laminas. The increase in the corneal cell density was not significantly correlated with the presence the fibrotic tissue.

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