Midterm results on ocular surface reconstruction using cultivated autologous oral mucosal epithelial transplantation.
OBJECTIVE
To perform a midterm assessment of the integrity and reproducibility of cultivated autologous oral mucosal epithelial sheets, and to evaluate the clinical efficacy of their transplantation in ocular surface.


METHODS
Observational case series.


METHODS
Cultivated autologous oral mucosal epithelial sheets were created using amniotic membrane and buccal mucosal epithelium from 12 patients with Stevens-Johnson syndrome, chemical and thermal injury, pseudo-ocular cicatricial pemphigoid, and idiopathic ocular surface disorder. They were transplanted onto 15 eyes from these patients who were then followed up for a mean of 20 months; with the longest follow-up being 34 months. We assessed their clinical outcomes with special reference to neovascularization.


RESULTS
Cultivated autologous oral mucosal epithelial sheets could be generated from all patients. On the second postoperative day, 14 of 15 sheets transplanted demonstrated total re-epithelialization on the cornea. During the follow-up, the ocular surface was stable and transparent without any major complications in 10 of 15 eyes (67%), and the transplanted epithelium survived for at least 34 months. There were five eyes (33%) with small but long-standing epithelial defects, three of these healed spontaneously, and two (13%) required reoperation. In 10 eyes, postoperative visual acuity was improved by more than 2 lines. All eyes manifested some peripheral corneal vascularization.


CONCLUSIONS
We established a successful tissue-engineering technique to generate cultivated autologous oral mucosal epithelial sheets and succeeded in reconstructing the ocular surface. We suggest that this surgical modality may be both safe and useful, especially in younger patients with the most severe ocular surface disorders.
Inatomi
Tsutomu
T
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Nakamura
Takahiro
T
Koizumi
Noriko
N
Sotozono
Chie
C
Yokoi
Norihiko
N
Kinoshita
Shigeru
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion; D017690:Cell Transplantation; D002478:Cells, Cultured; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery*; D004847:Epithelial Cells / Q000502:physiology / Q000637:transplantation*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000166:cytology*; D023822:Tissue Engineering; D014182:Transplantation, Autologous; D016896:Treatment Outcome