Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity.
OBJECTIVE
To assess the clinical efficacy of cultivated oral mucosal epithelial transplantation (COMET) for the treatment of persistent epithelial defect (PED).


METHODS
We treated 10 eyes of nine patients with PED (Stevens-Johnson syndrome: three eyes; thermal/chemical injury: five eyes; ocular cicatricial pemphigoid: two eyes) with COMET at Kyoto Prefectural University of Medicine, Kyoto, Japan from 2002 to 2008.


RESULTS
Preoperatively, PED existed on over more than 50% of the corneal surface in seven eyes. Severe ocular surface inflammation with fibrovascular tissue surrounded the PED in all 10 eyes. At 24-weeks postoperative, PED had improved in all cases except 1 in which the patient was unable to return to the hospital (95% CI, 55.5-99.7; Wilcoxon signed-rank test, p = 0.0078). The preoperative median of logarithmic minimum angle of resolution was 1.85 (range 0.15-2.70), and 1.85, 1.85, and 1.52 at the 4th, 12th, and 24th postoperative week, respectively. The mean total preoperative ocular surface grading score was 7.0 (range 4-17). At 4 and 12 weeks postoperative, the total ocular surface grading score had improved significantly (p = 0.0020, p = 0.0078), and at 24 weeks postoperative, it was 3.0 (range 2-12, p = 0.0234). During the follow-up period (median 23.3 months, range 5.6-39.7 months), no recurrence of PED was observed in any eye, and long-term ocular surface stability was obtained.


CONCLUSIONS
COMET enabled complete epithelialization of PED and stabilization of the ocular surface in patients with severe ocular surface disease, thus preventing end-stage cicatrization and vision loss at a later stage.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Chie
C
Sotozono
Tsutomu
T
Inatomi
Takahiro
T
Nakamura
Noriko
N
Koizumi
Norihiko
N
Yokoi
Mayumi
M
Ueta
Kotone
K
Matsuyama
Hideaki
H
Kaneda
Masanori
M
Fukushima
Shigeru
S
Kinoshita
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002057:Burns, Chemical / Q000473:pathology / Q000601:surgery*; D017690:Cell Transplantation; D002478:Cells, Cultured; D002648:Child; D065306:Corneal Injuries / Q000473:pathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation*; D005126:Eye Burns / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000166:cytology*; D010390:Pemphigoid, Benign Mucous Membrane / Q000473:pathology / Q000601:surgery*; D062326:Re-Epithelialization; D013262:Stevens-Johnson Syndrome / Q000473:pathology / Q000601:surgery*; D014792:Visual Acuity
acute inflammatory activity; cultivated oral mucosal epithelial transplantation (COMET); limbal stem cell deficiency (LSCD); persistent epithelial defect (PED)