Abstract
Purpose::
To report on the efficacy and clinical outcome of the 2-step surgical combination of cultivated autologous oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty (PKP) in severe ocular surface disorders. Characteristics of survived oral mucosal epithelium and reconstructed ocular surfaces were investigated.
Methods::
The clinical outcome of this 2-step procedure was evaluated retrospectively. Subjects involved 5 eyes in 5 cases including 3 eyes of chemical burn, 1 eye of Stevens-Johnson syndrome, and 1 eye of idiopathic ocular surface disease. The mean age was 62 years, and the observation period was 20.8 months. Autologous cultivated oral mucosal epithelial sheets on amniotic membrane were generated from a small size of oral buccal biopsy. Initially, the cicatrizing ocular surfaces were reconstructed using COMET, followed approximately 6 months later by a PKP triple-procedure. Clinical manifestations were assessed by slit-lamp. In vivo laser confocal microscopy was used to analyze the structure of the epithelium on the corneal grafts. Immunohistochemical study was performed to analyze the excised grafts.
Results::
Transplanted cultivated oral mucosal epithelium survived on the ocular surface in all patients. No clinical complications, such as endothelial rejections or recurrence of cicatrisation, were encountered. Corneal grafts remained clear during the follow-up period. Postoperative best-corrected visual acuity was improved in all cases, and ranged from 0.2 to 0.4. The surviving oral mucosal epithelium, distinguished by its fluorescence pattern, consisted of an irregular, non-keratinized, stratified epithelium without goblet cells. In vivo, the epithelial structure and cell density in the basal cell layer of the corneal grafts were similar to normal corneas. Survived oral mucosal epithelium showed similar keratin expression pattern with the oral mucosal tissue.
Conclusions::
Ocular surfaces were successfully reconstructed using a 2-step combination of COMET and PKP. Surrounding oral mucosal epithelial stem cells may reduce the immunological reaction against allograft and support the maintenance of the ocular surface. This surgical modality improves the visual prognosis of corneal stem cell deficiency.
Keywords: cornea: clinical science • cornea: epithelium • transplantation