Corneal Stroma Enhancement With Decellularized Stromal Laminas With or Without Stem Cell Recellularization for Advanced Keratoconus

Barrio, Jorge L. Alió del; Zarif, Mona El; Azaar, Albert; Makdissy, Nehman; Khalil, Charbel; Harb, Walid; Achkar, Ibrahim El; Jawad, Ziad Abdul; Miguel, María P. De; Alió, Jorge L.

doi:10.1016/j.ajo.2017.10.026

Cited by 97 publications

(145 citation statements)

References 24 publications

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“…We report herein the results of our evaluation of the evolution of corneal stroma cellularity, studied with corneal confocal microscopy, in eyes that have been the subject of corneal regeneration experiences. [14][15][16] The visual and refractive results from the interim analyses of this cohort performed by our group at 6 and 12 months have been reported in previous publications. [14][15][16] Here, we report the changes induced in the cellularity and distribution of corneal cells following implantation of ADASCs, alone or via decellularized laminas as carriers, after 1 year of follow-up.…”

mentioning

confidence: 56%

“…The inclusion and exclusion criteria of the study have been defined in our previous publications on this clinical study. [14][15][16] Surgical Procedure Autologous ADASC Implantation. Topical anesthesia was used, and a 60-kHz IntraLase iFS femtosecond laser (Abbott Medical Optics, Inc., Irvine, CA, USA) was utilized in single-pass mode for the recipient corneal lamellar dissection.…”

Section: Study Design and Patientsmentioning

confidence: 99%

“…Recently, we proposed the clinical use of acellular corneal tissue, with or without autologous stem cell repopulation, to increase the corneal thickness and to promote the production of new collagen, aiming to improve the biological and clinical condition of the keratoconic cornea and halting the progression of the disease. [14][15][16][17][18][19] Based on these reports, the use of mesenchymal stem cells such as autologous adipose-derived adult stem cells (ADASCs) or corneal stroma decellularized laminas with or without ADASC recellularization implanted in the corneal stroma has become a promising therapeutic option for keratoconus treatment.…”

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confidence: 99%

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Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study

Zarif

Jawad²,

Barrio

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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To report the corneal stroma cell density evolution identified by in vivo corneal confocal microscopy in humans using injected autologous adipose-derived adult stem cells (ADASCs) and corneal decellularized laminas in corneas with advanced keratoconus. METHODS. Interventional prospective, consecutive, randomized, comparative series of cases. A total of 14 keratoconic patients were randomly distributed into three groups for three types of surgical interventions: group 1 (G-1), autologous ADASC implantation (n = 5); group 2 (G-2), decellularized human corneal stroma (n = 5); and group 3 (G-3), autologous ADASCs + decellularized human corneal stroma (n = 4). RESULTS. A gradual and significant increase (P < 0.001) was observed in the cellularity in the anterior and posterior stroma of patients in G-1, G-2, and G-3 a year after the surgery in comparison with the preoperative density level. The same result was observed at the mid-corneal stroma in G-1 and at the anterior and posterior surfaces and within the laminas in G-2 and G-3. The cell density of patients receiving ADASC recellularized laminas (G-3) was statistically significantly higher (P = 0.011) at the anterior surface and within the lamina (P = 0.029) and at the posterior surface than in those implanted only with decellularized laminas (G-2). CONCLUSIONS. A significant increase in cell density occurred up to 1 postoperative year at the corneal stroma following the implantation of ADASCs alone, as well as in those cases implanted with decellularized and recellularized laminas at the different levels of the analysis. However, this increase was significantly higher in the ADASC recellularized laminas.

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confidence: 56%

Section: Study Design and Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

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Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study

Zarif

Jawad²,

Barrio

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…Human adipose‐derived stem cells have also been used to recellularize decellularized human corneas and differentiate into functional keratocytes in the stroma . This same technique exhibited functional biocompatibility with thin human corneal stromal laminas (created by femtosecond laser) which were successfully and safely transplanted into patients in a clinical trial . As an alternative to injections and cell cultures, bioreactor platforms can be a useful technique for the recellularization of stroma.…”

Section: Recellularizationmentioning

confidence: 99%

Decellularization methods for developing porcine corneal xenografts and future perspectives

Isidan

Liu

et al. 2019

Xenotransplantation

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Corneal transplantation is the only option to cure corneal opacities. However, there is an imbalance between supply and demand of corneal tissues in the world. To solve the problem of corneal shortage, corneal xenotransplantation studies have been implemented in the past years using porcine corneas. The corneal xenografts could come from (a) wild‐type pigs, (b) genetically engineered pigs, (c) decellularized porcine corneas, and (d) decellularized porcine corneas that are recellularized with human corneal cells, eventually with patients' own cells, as in all type of xenografts. All approaches except, the former would reduce or mitigate recipient immune responses. Although several techniques in decellularization have been reported, there is still no standardized protocol for the complete decellularization of corneal tissue. Herein, we reviewed different decellularization methods for porcine corneas based on the mechanism of action, decellularization efficacy, biocompatibility, and the undesirable effects on corneal ultrastructure. We compared 9 decellularization methods including: (a) sodium dodecyl sulfate, (b) triton x‐100, (c) hypertonic saline, (d) human serum with electrophoresis, (e) high hydrostatic pressure, (f) freeze‐thaw, (h) nitrogen gas, (h) phospholipase A2, and (i) glycerol with chemical crosslinking methods. It appears that combined methods could be more useful to perform efficient corneal decellularization.

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“…Кератоконус (КК) относится к хроническим дегенеративным заболеваниям роговицы, приводящим к нарушению биомеханики роговицы, изменению ее формы и к зрительным дисфункциям [1][2][3]. Поражение глаз, как правило, происходит асимметрично и имеет наследственно обусловленный характер [4,5].…”

Section: Introductionunclassified

Repeated Corneal Cross-Linking with Progressive Keratoconus

Usubov

2019

Oftalʹmologiâ

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The purpose is to study the efficacy and safety of repeated UV corneal crosslinking in patients with advanced keratoconus after transepithelial crosslinking performed previously. Patients and methods. A retrospective analysis of the treatment results of 52 patients (52 eyes) with progressive keratoconus stage I-II according to the Amsler — Krumeich classification, which from 2012 to 2014 were treated by transepithelial corneal crosslinking. Based on objective clinical studies, the effectiveness of the treatment and the course of the process were evaluated. In some patients with a progressive course of the process (12 eyes), after the transepithelial crosslinking, a procedure of repeated UV crosslinking of the cornea was performed according to a standard protocol. Results. After transepithelial cross-linking within 24 months in 12 eyes (44 %) progression of the disease was observed, manifested by an increase in the refractive power of the cornea by 0.95 ± 0.18 D, a decrease in the thickness of the cornea from 484 ± 156 to 446 ± 87 microns. Repeated cross-linking was performed and after 6 months and positive dynamics was observed in 10 cases (83.3 %), visual acuity reached the preoperative level, the refractive power of the cornea was 50.3 ± 0.84 D. Stabilization of the process was noted in all 12 eyes, a decrease in the average refractive index of the cornea by an average of 1.1 ± 1.25 D, corneal astigmatism — by 1.2 ± 0.31 D, the cornea thickness to 427 ± 38.7 mc.Conclusion. The use of modified crosslinking protocols, in particular transepithelial with iontophoresis, has a lower efficiency, showing stabilization in 56 % of cases, compared to the standard, which must be considered when choosing a clinical approach and selecting patients. Performing recrosslinking using a standard protocol showed high efficiency and safety of the procedure in 100 % of cases, however, this approach should be studied on a larger number of observations.

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Corneal Stroma Enhancement With Decellularized Stromal Laminas With or Without Stem Cell Recellularization for Advanced Keratoconus

Cited by 97 publications

References 24 publications

Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study

Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study

Decellularization methods for developing porcine corneal xenografts and future perspectives

Repeated Corneal Cross-Linking with Progressive Keratoconus

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