Cultivated Oral Mucosa Epithelium in Ocular Surface Reconstruction in Aniridia Patients

Abstract

Purpose. Efficacy of cultivated oral mucosa epithelial transplantation (COMET) procedure in corneal epithelium restoration of aniridia patients. Methods. Study subjects were aniridia patients (13 patients; 17 eyes) with irregular, vascular conjunctival pannus involving visual axis who underwent autologous transplantation of cultivated epithelium. For the procedure oral mucosa epithelial cells were obtained from buccal mucosa with further enzymatic treatment. Suspension of single cells was seeded on previously prepared denuded amniotic membrane. Cultures were carried on culture dishes inserts in the presence of the inactivated with Mitomycin C monolayer of 3T3 fibroblasts. Cultures were carried for seven days. Stratified oral mucosa epithelium with its amniotic membrane carrier was transplanted on the surgically denuded corneal surface of aniridia patients with total or subtotal limbal stem cell deficiency. Outcome Measures. Corneal surface, epithelial regularity, and visual acuity improvement were evaluated. Results. At the end of the observation period, 76.4% of the eyes had regular transparent epithelium and 23.5% had developed epithelial defects or central corneal haze; in 88.2% of cases visual acuity had increased. VA range was from HM 0.05 before the surgery to HM up to 0.1 after surgery. Conclusion. Application of cultivated oral mucosa epithelium restores regular epithelium on the corneal surface with moderate improvement in quality of vision.

Cell culture models of oral mucosal barriers: A review with a focus on applications, culture conditions and barrier properties

“…In oral and maxillofacial surgery, the main objective is the development of biocompatible oral mucosa equivalents as suitable graft materials. Extensive research is done on models for clinical applications such as burn treatment, 270 ocular surface reconstruction 271,272 or substitution urethroplasty. 273,274 Oral mucosa engineering in terms of advantages and disadvantages of different experimental set-ups, cell sources, scaffolds and applications for oral mucosa engineering has been extensively reviewed previously.…”

Human limbal niche cells are a powerful regenerative source for the prevention of limbal stem cell deficiency in a rabbit model

“…Over the past decades, several medical treatments for LSCD have been reported including amniotic membrane transplantation, autograft LSC and oral mucosa transplantation, allograft LSC and oral mucosa transplantation, and bone marrow derived mesenchymal stem cells (BMMSC) or epithelial stem cells derived from corneal epithelial cells. However, there is still no optimal treatment probably due to lack of knowledge of the underlying mechanisms during LSCD occurrence and recovery 2 , 3 .…”

Clinical Outcomes From Cultivated Allogenic Stem Cells vs. Oral Mucosa Epithelial Transplants in Total Bilateral Stem Cells Deficiency

“…Patients with Stevens-Johnson syndrome had a more stable epithelium after CLET than patients with LSCD following burns or OCP. In one study which studied results of CLET in patients with aniridia, 3 out of the 13 female patients included had a lower rate of epithelium regularity (42). Ganger et al (29) followed the longterm outcomes in children and adults following CLET, however comparison between the two groups was not done due to the small number of patients.…”

“…In most cases, cultured sheets were not secured with sutures (13,14,35,37,43), however a therapeutic contact lens was used over the transplant. Nonetheless, a few authors reported suturing cultivated sheets to the conjunctiva (36,38,42). With patients also suffering from cataract, phacoemulsification and posterior chamber implant were performed simultaneously with COMET (40).…”

“…Similarly, following COMET/CAOMECS, patients received antibiotics and anti-inflammatory agents [topical or general corticosteroids, or Cyclosporine (37)], in order to keep inflammation to the minimum, and artificial tears (13,14,(35)(36)(37)(38)(40)(41)(42)(43). In some studies, autologous serum drops were used also (41,42,47).…”