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J. Shimazaki, Y. Satake, M. Kawashima, K. Higa, S. Shimmura, K. Tsubota; Outcome of Cultivated Oral Mucosal Epithelial Transplantation in Severe Bilateral Ocular Surface Disorders . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3938.
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© ARVO (1962-2015); The Authors (2016-present)
Ex vivo cultivated oral mucosal epithelial transplantation (COMET) is a recently developed surgical approach for severe ocular surface disorders. The method includes cultivating autologous oral mucosal epithelium on preserved human amniotic membrane and transplantation on the ocular surface following removal of cicatricial tissue. The method has an advantage that no long–term immunosuppression is needed. The aim of the present study is to report outcomes of COMET for bilateral ocular surface diseases.
COMET was performed in 20 eyes of 19 patients that had cicatricial keratoconjunctivitis associated with total limbal dysfunction. Patients consisted of 13 males and 6 females with a mean age of 58 years. Original diseases were; Stevens–Johnson syndrome (n=5), ocular cicatricial pemphigoid (OCP, n=5), pseudo–OCP (n=5), chemical/thermal burns (n=5). Eleven eyes had symblepharon or shortened fornix. Nine eyes had COMET for corneal surface reconstruction, 4 eyes for both corneal and conjunctival reconstruction, and 7 eyes for conjunctival reconstruction only. Three eyes received keratoplasty following COMET for visual rehabilitation. The excised corneal tissues were subjected to histological examination and immunohistochemistry for keratin 3, and 13.
With a mean follow–up period of 10 months (range; 2–21), 10 of 13 eyes that had COMET for corneal surface reconstruction achieved stable ocular surface. In these eyes, fibrosis and vascularization were markedly regressed although visual acuity was not significantly improved. Three of these eyes that had secondary keratoplasty showed clear grafts and significant improvements in visual acuity. Histological examination revealed that the corneal surface was covered by multi–layered epithelial cells that were negative for keratin 3 and faint staining for keratin 13. Nine of 11 eyes achieved deep fornix or lysis of symblepharon. As complications, 2 eyes had persistent epithelial defects, 2 had recurrence of symblepharon, 3 had postoperative glaucoma, and one had corneal perforation. No infection or immunological rejection was noted.
COMET seems to be a useful alternative for reconstruction of bilateral ocular surface disorders. Since stable ocular surface status can be obtained in many cases following COMET, subsequent keratoplasty may be useful for visual recovery.
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