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Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders
  1. Takahiro Nakamura1,2,
  2. Kazunori Takeda1,
  3. Tsutomu Inatomi1,
  4. Chie Sotozono1,
  5. Shigeru Kinoshita1
  1. 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
  2. 2Research Center for Inflammation and Regenerative Medicine, Doshisha University, Kyoto, Japan
  1. Correspondence to Takahiro Nakamura, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841 Japan; tnakamur{at}koto.kpu-m.ac.jp

Abstract

Purpose 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.

  • Cornea
  • oral mucosa
  • amniotic membrane
  • severe ocular surface disease
  • ocular surface
  • conjunctiva, cornea
  • treatment surgery
  • clinical trial

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Footnotes

  • TN and KT contributed equally to this work.

  • Funding Supported in part by Grants-in-Aid for scientific research from the Japanese Ministry of Health, Labour and Welfare (H16–Saisei-007), and the Japanese Ministry of Education, Culture, Sports, Science and Technology (Kobe Translational Research Cluster), a research grant from the Kyoto Foundation for the Promotion of Medical Science, and the Intramural Research Fund of Kyoto Prefectural University of Medicine.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board for Human Studies of Kyoto Prefectural University of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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