Visual improvement after cultivated oral mucosal epithelial transplantation.
OBJECTIVE
To report the effectiveness, disease-specific outcomes, and safety of cultivated oral mucosal epithelial sheet transplantation (COMET), with the primary objective of visual improvement.


METHODS
Noncomparative, retrospective, interventional case series.


METHODS
This study involved 46 eyes in 40 patients with complete limbal stem cell deficiency (LSCD) who underwent COMET for visual improvement. These LSCD disorders fell into the following 4 categories: Stevens-Johnson syndrome (SJS; 21 eyes), ocular cicatricial pemphigoid (OCP; 10 eyes), thermal or chemical injury (7 eyes), or other diseases (8 eyes).


METHODS
Best-corrected visual acuity (BCVA) and ocular surface grading score were examined before surgery; at the 4th, 12th, and 24th postoperative week; and at the last follow-up. Data on COMET-related adverse events and postoperative management were collected. The outcomes in each disease category were evaluated separately.


METHODS
The primary outcome was the change in median logarithm of the minimum angle of resolution (logMAR) BCVA at the 24th postoperative week. The secondary outcome was the ocular surface grading score.


RESULTS
Median logMAR BCVA at baseline was 2.40 (range, 1.10 to 3.00). In SJS, logMAR BCVA improved significantly during the 24 weeks after surgery. In contrast, the BCVA in OCP was improved significantly only at the 4th postoperative week. In 6 of the 7 thermal or chemical injury cases, logMAR BCVA improved after planned penetrating keratoplasty or deep lamellar keratoplasty. Grading scores of ocular surface abnormalities improved in all categories. Of 31 patients with vision loss (logMAR BCVA, >2) at baseline, COMET produced improvement (logMAR BCVA, ≤2) in 15 patients (48%). Visual improvement was maintained with long-term follow-up (median, 28.7 months). Multivariate stepwise logistic regression analysis showed that corneal neovascularization and symblepharon were correlated significantly with logMAR BCVA improvement at the 24th postoperative week (P=0.0023 and P=0.0173, respectively). Although postoperative persistent epithelial defects and slight to moderate corneal infection occurred in the eyes of 16 and 2 patients, respectively, all were treated successfully with no eye perforation.


CONCLUSIONS
Long-term visual improvement was achievable in cases of complete LSCD. Cultivated oral mucosal epithelial sheet transplantation offered substantial visual improvement even for patients with end-stage severe ocular surface disorders accompanying severe tear deficiency. Patients with corneal blindness such as SJS benefited from critical improvement of visual acuity.


BACKGROUND
The author(s) have no proprietary or commercial interest in anymaterials discussed in this article.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. csotozon@koto.kpu-m.ac.jp
Chie
C
Sotozono
Tsutomu
T
Inatomi
Takahiro
T
Nakamura
Noriko
N
Koizumi
Norihiko
N
Yokoi
Mayumi
M
Ueta
Kotone
K
Matsuyama
Keiko
K
Miyakoda
Hideaki
H
Kaneda
Masanori
M
Fukushima
Shigeru
S
Kinoshita
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018929:Cell Culture Techniques; D002648:Child; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000166:cytology*; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology; D023822:Tissue Engineering / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*