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A. Solomon, G. Mafzir, F. Orukov, O. Hammad, J. Frucht-Pery, M. Sela; Cultured Oral Mucosal Epithelial Transplantation (COMET) in Total Limbal Stem Cell Deficiency. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6173.
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To report the results of ex-vivo cultured oral mucosal epithelial transplantation (COMET) in patients with total limbal stem cell deficiency (LSCD).
COMET was performed in 6 eyes of 6 patients with bilateral LSCD resulting from bilateral chemical burns (3 eyes), aniridia (2 eyes), and Stevens Johnson Syndrome (one eye). Autologus oral epithelium was cultured from oral mucosal biopsies on denuded amniotic membrane (AM) for 2-4 weeks, using the patient's autologus serum in the culture media. Ex-vivo cultured oral epithelial cells on AM were transplanted on the ocular surface of these patients following extensive removal of the fibrovascular tissue from the cornea and perilimbal areas.
Variable epithelial defects with partial dissolution of the AM were noted during the first 2 weeks after COMET, with complete corneal epithelialization after 4-6 weeks. The epithelium appeared smooth but opaque, and neovascularization was evident in the periphery of the cornea. In 2 patients with chemical burns the procedure failed, as the AM and the oral epithethelial cells sloughed away within the first week, followed by recurrence of conjunctivalization. In two patients, penetrating keratoplasty (PKP) was performed two years after COMET. After PKP, the donor cornea epithelialized within a few days. The transplanted cornea remained clear with a stable corneal epithelium 12 months after PKP. Histology of the removed corneal buttons showed variable stratification of the corneal epithelium, with no signs of the AM.
Ex-vivo oral epithelial cell transplantation cultured on the amniotic membrane followed by penetrating keratoplasty appears to be an effective method for the management of selected patients with bilateral total limbal stem cell deficiency.
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