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J. Kim, Y. Chun, H. Jeong, S. Lee, Y. Son, J. Kim; Nasal Mucosal Transplantation in Cicatrical Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1520.
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To investigate the possibility of replacing cicatrical ocular surface with nasal mucosa, and to evaluate the efficacy of autologous nasal mucosa and oral mucosa transplantation in cicatrical ocular surface disease.
Six eyes of six patients with chemical burn, and three eyes of three patients with severe recurrent pterygium were included. Nasal mucosal autografts or oral mucosal autograft with limbal autograft in the extensive damaged ocular surface were performed. Nasal and oral mucosa examined by histologic and immunohistochemical analysis for p63, CK3, MUC5AC, and CD34.
Immunohistochemical analysis revealed plenty of the p63 and CK3 in both nasal and oral mucosal epithelium. But goblet cells(MUC5AC expressions) were only observed in nasal mucosal epithelium, not in oral mucosal epithelium. The vascular plexus of the nasal mucosa showed horizontal direction, while that of the oral mucosa showed vertical direction. This remarkable vascular feature remained after transplantation of nasal and oral mucosa as well. Ocular surface was stabilized and restored in all patients. Well-developed nasal mucosal vascularization to support limbal graft survival and increased mucin secretion to be needed for the ocular surface maintenance were observed. But on the oral mucosal graft sites, poor epithelization and ischemic changes were shown which seemed to be strongly related with vasculature.
Nasal mucosa which has the advantage of well-developed horizontal vasculature, enriched goblet cells, and plenty of stem cells, may be an ideal substitute for the cicatrical ocular surface.
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