Official ESCRS | European Society of Cataract & Refractive Surgeons


Corneal stroma regeneration with cellular therapy: confocal study

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Session Details

Session Title: Ocular Pathology/Education & Training

Session Date/Time: Tuesday 17/09/2019 | 14:00-16:00

Paper Time: 14:30

Venue: Free Paper Forum: Podium 4

First Author: : M.El Zarif SPAIN

Co Author(s): :    J. Alió   J. Alió Del Barrio                          

Abstract Details


Managing Keratoconus is performed by following different surgical approaches, recently we described a new surgical approach by regenerative medicine using autologous mesenchymal stem cells ((ADAS) and descellularized corneal tissue. We report herein the corneal confocal microscopy evolution in vivo of injected stem cells (ADAS) into the human cornea affected by advanced keratoconus and their transformation along one year follow up into keratocytes, the evolution of corneal decellularized laminas implanted without ADAS cells, and the evolution of ADAS cells implanted on the decellularized corneal laminas.


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


Confocal microscopy was performed in a clinical Phase I experimental, prospective consecutive series of cases. 14 keratoconic patients were included in 3 groups and submitted to different surgical approximations: Group 1: Autologous ADASC implantation (5 patients), Group 2: Decellularized human corneal stroma implantation (5 patients), Group 3: Autologous ADASC + Decellularized human corneal stroma implantation (4 patients). An original method of quantitative confocal microscope study cell counting was used to evaluate the evolution of cell density. We also studied the morphological evolution of the implanted cells, the acellular laminas and the recellularized ones along the follow up of the study.


We observed in comparison to the preoperative cellular density, a gradual increase (P value = 0.07) of the cells density in the anterior, middle and posterior stroma of the patients with implanted ADASC one year after the operation,. Keratocyte density in both anterior and posterior (P value = 0.008) stroma of patients with decellularized lamina and recellularized lamina, was statistically significant higher one year postoperatively. We could also demonstrate a significant (p< 0.05) increase in the keratocyte density within the lamina. The cell density with recellularized laminas was significantly higher than those patients treated with a decellularized lamina.


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 the cellularity of the corneal stroma following the implantation of ADASC cells alone, and also an increase in keratocytes of patients with implanted decellularized and recellularized laminas.

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