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Long term results after autologous nasal mucosal transplantation in severe mucus deficiency syndromes
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  1. Hartmut Wenkel,
  2. Volker Rummelt,
  3. Gottfried O H Naumann
  1. Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
  1. Hartmut Wenkel, MD, Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany

Abstract

AIM Severe mucus deficiency syndromes may require substitution of mucous membrane for re-establishment of the ocular surfaces. The long term results after autologous nasal mucosal transplantation were investigated.

METHODS 55 eyes of 50 patients with severe mucus deficiency syndromes were followed retrospectively after free autologous nasal mucosal transplantation—group A: patients after severe lye, acid, heat burns, or radiation (n=38 eyes), group B: patients with systemic mucosal disease (n=17 eyes). The results of routine clinical examination were recorded and patients were followed for a median of 37 months. 17 biopsies of transplanted nasal mucosa were studied by light microscopy and 22 patients by impression cytology before and at several intervals after mucosal transplantation.

RESULTS All nasal mucosal grafts healed well and no intraoperative complications occurred. During follow up 107 additional surgical procedures were performed including 16 lamellar and 21 penetrating keratoplasties. Subjective complaints improved in 44/47 patients with preoperative symptoms. Best corrected visual acuity at the end of follow up was increased in 23 eyes, 10 eyes (18.2%) reached a final visual acuity equal to or greater than 20/200. Histopathologically, all (n=17) biopsies showed vital intraepithelial mucin producing goblet cells in the nasal mucosal graft (median 25 cells/field (400× magnification)). The mean density of goblet cells before transplantation was 48/mm2 and after nasal mucosal grafting 432/mm2measured by impression cytology (p<0.0001).

CONCLUSIONS Functional goblet cells persist in autologous nasal mucosa for up to 10 years after transplantation. In patients with severe mucus deficiency syndromes of different origin nasal mucosal transplantation can re-establish the ocular surface, substitute the mucus components of the tear film, improve symptoms of the patients, and facilitate a moderate increase in visual acuity.

  • nasal mucosal transplantation
  • mucus deficiency
  • impression cytology
  • ocular surface disorder
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