July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Using in vivo confocal microscopy to detect the effects of oral mucosal graft on lid margin pathologies in cicatricial ocular surface diseases
Author Affiliations & Notes
  • Chin-Te Huang
    Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
    Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
  • Yi-Hsuan Wei
    Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
  • Hsiao-Sang Chu
    Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
    Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
  • Wei-Li Chen
    Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
    Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
  • Footnotes
    Commercial Relationships   Chin-Te Huang, None; Yi-Hsuan Wei, None; Hsiao-Sang Chu, None; Wei-Li Chen, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 139. doi:
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      Chin-Te Huang, Yi-Hsuan Wei, Hsiao-Sang Chu, Wei-Li Chen; Using in vivo confocal microscopy to detect the effects of oral mucosal graft on lid margin pathologies in cicatricial ocular surface diseases. Invest. Ophthalmol. Vis. Sci. 2018;59(9):139.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Lid margin keratinization, trichiasis, distichiasis and incomplete closure of eyelids are commonly found in patients with cicatricial ocular surface diseases. We aimed to use in vivo confocal microscopy to detect the ocular surface changes in patients who underwent oral mucosal graft for lid margin pathologies.

Methods : Six eyes of 4 patients with Stevens-Johnson syndrome received oral mucosal graft to correct lid margin pathologies for cicatricial ocular surface diseases. Serial changes on the corneal surface were evaluated by slit lamp biomicroscopy and in vivo confocal microscopy. Postoperative manifestation of the eyelid margin was analyzed. Impression cytology was combined with immunohistochemical staining for detection of keratin 3 (K3)/ keratin 12 (K12), keratin 4 (K4)/ keratin 13 (K13) and mucin 5AC (Muc5AC) on the corneal surface.

Results : After operation, all eyes were found to have improved eyelid margin keratinization, trichiasis, distichiasis and incomplete closure. Inflammation on the ocular surface and corneal surface ablation also improved. Keratinization of corneal surface decreased slowly but significantly after surgery. In vivo confocal microscopy in most patients demonstrated clear demarcation between healthy corneal epithelial cells and keratinized squamous cells without evidence of goblet cell invasion. Impression cytology demonstrated K3/K12 positive cells without detectable K4/K13 or Muc5AC in most cases. After surgery, the morphology of corneal surface cells gradually returned to normal. Corneal surface squamous metaplasia instead of limbal insufficiency played an important role in ocular surface manifestation before surgery.

Conclusions : Oral mucosal graft is an effective treatment to correct lid margin pathologies commonly found in cicatricial ocular surface diseases. In vivo confocal microscopy can be used to differentiate corneal surface pathologies before planning for further limbal transplantation or cell therapy, and can be used to monitor postoperative conditions.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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