title: Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders.
abstract: OBJECTIVE
  To investigate the long-term outcome of autologous cultivated oral mucosal epithelial transplantation (COMET) for the treatment of the scar phase of severe ocular surface disorders. Participants This study involved 19 eyes of 17 patients who received autologous COMET for total limbal stem-cell deficiency.
  
  
  METHODS
  Autologous cultivated oral mucosal epithelial sheets were created using amniotic membrane as a substrate. Clinical efficacy was evaluated by best-corrected visual acuity and visual acuity at the postoperative 36th month. The clinical results (clinical conjunctivalisation, corneal opacification, corneal neovascularisation and symblepharon formation) were evaluated and graded on a scale from 0 to 3 according to their severity. Clinical safety was evaluated by the presence of persistent epithelial defects, ocular hypertension and infections.
  
  
  RESULTS
  Autologous cultivated oral mucosal epithelial sheets were successfully generated for all 17 patients. All patients were followed up for more than 36 months; the mean follow-up period was 55 months and the longest follow-up period was 90 months. During the long-term follow-up period, postoperative conjunctivalisation and symblepharon were significantly inhibited. All eyes manifested various degrees of postoperative corneal neovascularisation, but it gradually abated and its activity was stable at 6 months after surgery. Best-corrected visual acuity was improved in 18 eyes (95%) during the follow-up periods, and visual acuity at the postoperative 36th month was improved in 10 eyes (53%).
  
  
  CONCLUSIONS
  These long-term clinical results strongly support the conclusion that tissue-engineered cultivated oral mucosal epithelial sheets are useful in reconstructing the ocular surface of the scar phase of severe ocular surface disorders.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841 Japan. tnakamur@koto.kpu-m.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Takeda
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002478:Cells, Cultured; D002921:Cicatrix / Q000473:pathology / Q000601:surgery*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation* / Q000648:ultrastructure; D019573:Epithelium, Corneal / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D008875:Middle Aged; D009061:Mouth Mucosa / Q000166:cytology*; D033581:Stem Cell Transplantation / Q000379:methods; D023822:Tissue Engineering / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult