title: Ocular surface reconstruction with combination of cultivated autologous oral mucosal epithelial transplantation and penetrating keratoplasty.
abstract: OBJECTIVE
  To report an assessment of the two-step surgical combination of cultivated autologous oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty (PKP) used to treat patients with severe limbal deficiency disorders, and to investigate the keratin expression patterns of transplanted surviving oral mucosal epithelium.
  
  
  METHODS
  Observational case series.
  
  
  METHODS
  Two patients with Stevens-Johnson syndrome and chemical eye injury were treated by COMET followed, approximately six months later, by a PKP triple procedure. In the course of a mean follow-up period of 22.5 months, their clinical outcomes and the efficacy of this two-step surgical procedure were assessed. In addition, the keratin expression in corneal buttons excised during PKP were immunohistochemically examined to characterize the oral mucosal epithelium that survived ectopically on the cornea. In vivo laser confocal microscopy was used to investigate the structure of the epithelium on the corneal grafts.
  
  
  RESULTS
  The ocular surfaces were successfully reconstructed with cultivated autologous oral mucosal epithelial sheets and PKP. No clinical complications, such as persistent epithelial defects, rejections, or recurrence of cicatrization, were encountered. Postoperative best-corrected visual acuity was 20/125 in one patient and 20/100 in the other. The surviving oral mucosal epithelium, distinguished by its fluorescence pattern, consisted of an irregular, nonkeratinized, stratified epithelium without goblet cells. Immunohistochemical study demonstrated that K3, but not K12, was expressed in the transplanted cultivated oral mucosal epithelium that was similar to oral mucosal tissue. In vivo, the epithelial structure and cell density in the basal cell layer of the corneal grafts were similar to normal cornea.
  
  
  CONCLUSIONS
  This study presents a two-step surgical approach to treat severely scarred ocular surfaces by means of a combination of COMET and PKP. Clinical outcomes suggest that this treatment may be beneficial for the maintenance of the reconstructed ocular surface by providing oral mucosal epithelium around the corneal graft.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Hirokoji, Kyoto, Japan. tinatomi@ophth.kpu-m.ac.jp
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Mina
authors.initials: M
authors.lastname: Kojyo
authors.forename: Noriko
authors.initials: N
authors.lastname: Koizumi
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D002387:Cataract Extraction; D002452:Cell Count; D017690:Cell Transplantation; D002478:Cells, Cultured; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D003318:Corneal Opacity / Q000473:pathology / Q000601:surgery; D004847:Epithelial Cells / Q000378:metabolism / Q000637:transplantation*; D019573:Epithelium, Corneal / Q000473:pathology; D015590:Fluorophotometry; D006801:Humans; D007633:Keratins / Q000378:metabolism; D015948:Keratoplasty, Penetrating / Q000379:methods*; D019654:Lens Implantation, Intraocular; D008297:Male; D018613:Microscopy, Confocal; D009061:Mouth Mucosa / Q000166:cytology*; D013262:Stevens-Johnson Syndrome / Q000473:pathology / Q000601:surgery*; D014182:Transplantation, Autologous; D014792:Visual Acuity
chemical_list: D007633:Keratins