Ocular surface reconstruction with autologous nasal mucosa in cicatricial ocular surface disease.
OBJECTIVE
To investigate the possibility of replacing the metaplastic ocular surface with nasal mucosa, and to evaluate the results of autologous nasal and oral mucosal transplantation in cicatricial ocular surface diseases.


METHODS
Retrospective interventional case series.


METHODS
We studied 6 eyes in 6 patients with chemical burns, which were characterized by a cicatricial ocular surface. After removal of cicatricial tissues and symblepharolysis, autologous nasal mucosa was transplanted in all patients. In 3 patients with extensive damage, oral mucosal autografting was performed concurrently. The nasal and oral mucosa was evaluated using immunohistochemical analysis for p63, K3, MUC5AC, and CD34. Clinical outcomes were assessed based on visual acuity, ocular manifestations, and liquid-based cytology.


RESULTS
Immunohistochemical analysis revealed a plentitude of p63 and K3 in nasal mucosal epithelium. Goblet cells and MUC5AC expression were only observed in nasal mucosal epithelium, not in oral mucosal epithelium. Well-developed parallel vasculature was demonstrated in the nasal mucosa. In contrast, perpendicular vasculature was demonstrated in the oral mucosa. This vascular feature remained after transplantations. In all patients, ocular surface stability recovered with no major complications and increased goblet cells were observed on ocular surface. However, delayed epithelialization and ischemic thinning were seen at oral mucosal graft sites.


CONCLUSIONS
Nasal mucosa, which has the advantage of well-developed parallel vasculature, enriched goblet cells, and plenty of stem cells, may be an ideal substitute for a cicatricial ocular surface. Transplantation of autologous nasal mucosa is a very effective method for achieving ocular surface reconstruction in cicatricial ocular surface diseases.
Kim
Jae Hoon
JH
Department of Ophthalmology, College of Medicine, Chung-Ang University, Yongsan Hospital, Seoul, Republic of Korea.
Chun
Yeoun Sook
YS
Lee
Seok Hyun
SH
Mun
Seog Kyun
SK
Jung
Haeng Sun
HS
Lee
Su Hyon
SH
Son
Youngsook
Y
Kim
Jae Chan
JC
D000328:Adult; D018952:Antigens, CD34 / Q000378:metabolism; D002057:Burns, Chemical / Q000378:metabolism / Q000601:surgery*; D002921:Cicatrix / Q000378:metabolism / Q000601:surgery*; D003229:Conjunctival Diseases / Q000378:metabolism / Q000601:surgery*; D005126:Eye Burns / Q000139:chemically induced* / Q000378:metabolism; D006801:Humans; D007124:Immunoenzyme Techniques; D053558:Keratin-3 / Q000378:metabolism; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism; D008875:Middle Aged; D009061:Mouth Mucosa / Q000378:metabolism / Q000637:transplantation*; D055271:Mucin 5AC / Q000378:metabolism; D009297:Nasal Mucosa / Q000378:metabolism / Q000637:transplantation*; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014792:Visual Acuity
D018952:Antigens, CD34; C081876:CKAP4 protein, human; C479360:KRT3 protein, human; D053558:Keratin-3; C524678:MUC5AC protein, human; D008565:Membrane Proteins; D055271:Mucin 5AC