Autologous, Adipose Stem Cells Have Been Shown to Help Patients with Keratoconus

This is an exciting first step. It is too early to say this will be a cure, but we are all hopeful that this will prevent patients from needing a corneal transplant: which is a tough procedure as it means a lifetime of drops, on & off pain, & constant risk of rejection.


Issue: Volume 36(8), August 2017, p 952–960
Copyright: Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Publication Type: [Clinical Science]
DOI: 10.1097/ICO.0000000000001228
ISSN: 0277-3740
Accession: 00003226-201708000-00010
Keywords: stem cells, regenerative medicine, corneal transplant, cornea, cellular therapy, keratoconus, ADASC

Cellular Therapy With Human Autologous Adipose-Derived Adult Stem Cells for Advanced Keratoconus

Alió del Barrio, Jorge L. MD, PhD*,†; El Zarif, Mona OD; de Miguel, María P. PhD§; Azaar, Albert MD; Makdissy, Norman PhD; Harb, Walid MD; El Achkar, Ibrahim MD||; Arnalich-Montiel, Francisco MD, PhD**,††; Alió, Jorge L. MD, PhD, FEBOphth*,†

Author Information

*Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain;

Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain;

Optica General, Saida, Lebanon;

§Cell Engineering Laboratory, IdiPAZ, La Paz Hospital Research Institute, Madrid, Spain;

Reviva Regenerative Medicine Center, Beirut, Lebanon;

||Saint-Joseph University, Beirut, Lebanon;

**IRYCIS, Ophthalmology Department, Ramón y Cajal University Hospital, Madrid, Spain; and

††Cornea Unit, Hospital Vissum Madrid, Madrid, Spain.

Reprints: Jorge L. Alió, MD, PhD, FEBOphth, Avda de Denia s/n, Vissum, Instituto Oftalmologico de Alicante, 03016 Alicante, Spain (

The authors have no funding or conflicts of interest to disclose.

Received January 19, 2017

Received in revised form March 08, 2017

Accepted March 16, 2017


Purpose: The aim of this phase 1 study was to preliminarily evaluate the safety and efficacy of autologous adipose-derived adult stem cell (ADASC) implantation within the corneal stroma of patients with advanced keratoconus.

Methods: Five consecutive patients were selected. Autologous ADASCs were obtained by elective liposuction. ADASCs (3 × 106) contained in 1 mL saline were injected into the corneal stroma through a femtosecond-assisted 9.5-mm diameter lamellar pocket under topical anesthesia. Patients were reviewed at 1 day, 1 week, 1, 3, and 6 months postoperatively. Visual function, manifest refraction, slit-lamp biomicroscopy, intraocular pressure, endothelial cell density, corneal topography, corneal optical coherence tomography, and corneal confocal biomicroscopy were recorded.

Results: No intraoperative or postoperative complications were recorded, with full corneal transparency recovery within 24 hours. Four patients completed the full follow-up. All patients improved their visual function (mean: 1 line of unaided and spectacle-corrected distance vision and 2 lines of rigid contact lens distance vision). Manifest refraction and topographic keratometry remained stable. Corneal optical coherence tomography showed a mean improvement of 16.5 µm in the central corneal thickness, and new collagen production was observed as patchy hyperreflective areas at the level of the stromal pocket. Confocal biomicroscopy confirmed the survival of the implanted stem cells at the surgical plane. Intraocular pressure and endothelial cell density remained stable.

Conclusions: Cellular therapy of the human corneal stroma in vivo with autologous ADASCs appears to be safe. Stem cells survive in vivo with intrastromal new collagen production. Future studies with larger samples are required to confirm these preliminary results.
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