title: Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease.
abstract: The present study aimed to investigate the clinical outcomes of autologous cultivated oral mucosal epithelial transplantation (COMET) on human amniotic membrane (AM) for corneal limbal stem cell deficiency (LSCD). In this prospective, noncomparative case series, 20 eyes (18 patients) with bilateral severe ocular surface disease were chosen to undergo COMET on human AM. The primary outcome was clinical success, and the secondary outcomes were the best-corrected visual acuity difference, corneal opacification, symblepharon formation, and complications. The mean patient age was 48.2 ± 15.5 years. The mean follow-up time was 31.9 ± 12.1 months (range 8-50 months). All except one eye exhibited complete epithelialization within the first postoperative week. A successful clinical outcome, defined as a stable ocular surface without epithelial defects, a clear cornea without fibrovascular tissue invasion at the pupillary area, and no or mild ocular surface inflammation, was obtained in 15 of 20 eyes (75 %). The clinical success rate at 1 year was 79.3 %, and that at 4 years (end of follow-up) was 70.5 %. Fourteen of 20 (70 %) eyes exhibited improvement in visual acuity after COMET, and some required subsequent cataract surgery (2 eyes), penetrating keratoplasty (3 eyes), or keratoprosthesis implantation (1 eye). Preoperative symblepharon was eliminated in most eyes (8 of 13, 61.5 %) after COMET combined with eyelid reconstruction when needed. The only complication was corneal perforation (1 eye) induced by a severe eyelid abnormality; treatment with a tectonic corneal graft was successful. COMET can successfully restore ocular surface damage in most eyes with corneal LSCD.
authors: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi District, Bangkok, 10700, Thailand. pinnita.t@gmail.com.
authors: Pinnita
authors: P
authors: Prabhasawat
authors: Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Pattama
authors: P
authors: Ekpo
authors: Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Mongkol
authors: M
authors: Uiprasertkul
authors: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi District, Bangkok, 10700, Thailand.
authors: Suksri
authors: S
authors: Chotikavanich
authors: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi District, Bangkok, 10700, Thailand.
authors: Nattaporn
authors: N
authors: Tesavibul
authors: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi District, Bangkok, 10700, Thailand.
authors: Kanograt
authors: K
authors: Pornpanich
authors: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi District, Bangkok, 10700, Thailand.
authors: Panitee
authors: P
authors: Luemsamran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002478:Cells, Cultured; D003316:Corneal Diseases / Q000601:surgery / Q000628:therapy*; D016510:Corneal Neovascularization / Q000628:therapy; D003710:Demography; D004847:Epithelial Cells / Q000166:cytology* / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000166:cytology*; D011183:Postoperative Complications / Q000209:etiology; D060888:Real-Time Polymerase Chain Reaction; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Amniotic membrane; Corneal epithelial stem cell transplantation; Cultivated oral mucosal epithelial transplantation; Limbal stem cell deficiency; Ocular surface disease