Keratocytes Evolution in Advanced Regenerative Corneal Therapy with Keratoconus

Cellular therapy of the corneal stroma, either with ocular or extraocular stem cells, has gained significant interest over the last decade. Multiple studies showed benefits such as improving or alleviating corneal scars, improving corneal transparency, generating new collagen within the host stroma, and immunosuppressive and immunomodulatory properties. Mesenchymal stem cells, specifically adipose-derived adult stem cells (ADASCs), differentiate into functional adult keratocytes in vivo and in vitro. Alió et al. have carried out the first clinical, interventional prospective, consecutive, randomized, comparative series of cases on corneal stroma in 14 patients with advanced keratoconus. Patients were divided into three experimental groups. Group-1 (G-1) patients underwent implantation of (ADASCs) alone. Group-2 (G-2) patients received decellularized donor corneal stroma lamina (120 μm thickness). Group-3 (G-3) patients received implantation of donor lamina recellularized with (ADASCs). Autologous ADASCs were obtained by elective liposuction. Under topical anesthesia, implantation was performed into a femtosecond-assisted 9.5-mm diameter lamellar pocket. Follow-up data for 36 months were obtained. This chapter discusses the results of the evolution of corneal stroma cellularity, the morphological evolution of the implanted ADASCs, and the increase in cellularity associated with keratocyte morphological changes, all studied in vivo by using corneal confocal microscopy, together with corneal transparency, and corneal densitometry in patients with implanted ADASCs alone, which we named group A (G-A), and implanted recellularized laminas with ADASCs that have been the subject of a corneal regeneration experience that we named group B (G-B). The promising results obtained in this first human clinical experience of advanced therapy of the cornea with autologous mesenchymal stem cells indicate that we should expect from this new therapy a tremendous development in the following years in the treatment of cornea stromal disease.