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.

Diagnostic criteria for limbal stem cell deficiency before surgical intervention—A systematic literature review and analysis

“…Surgical treatment of LSCD had been offered at 66 eye centers in 23 countries in Europe, Asia, North America, and South America (Table 1). Of the 131 studies, 5 were uncontrolled clinical trials, 18,42,62,113,158 29 were prospective studies, 3,13,17,28,35,47,48,64,72,73,75,76,81,97,100,103,104,109,112,114,121,125,129,130,136,137,144,146,157 and 73 were retrospective studies. 1,2,5,7e12,14e16,20,24e26,31,32,39e41, 43,45,46,49,51e54,57,60,61,63,65,70,71, 77,78,83e91,95,98,99,106,108,116,118e120,122,123,126e128,131e135,139e142,147, 150,153,154 In the remaining 24 studies 6,29,37,38, 44,50,55,56,59,74,80,88,96,105,107,117,…”

Clinical Trials of Limbal Stem Cell Deficiency Treated with Oral Mucosal Epithelial Cells

“…In both of these cases, amniotic membranes were used as a carrier for cell sheet grafting and as feeder cells. Amniotic membranes are widely used for cornea cell sheet transplantation [79][80][81]; however, the availability is limited, and the membranes require the use of sutures to attach the cell sheet to the cornea. Mouse fibroblast feeder cells are used in co-culture with the amniotic membrane [59,[67][68][69][82][83][84][85][86][87][88][89].…”

Simple limbal epithelial transplantation: Current status and future perspectives

“…Among alternatives, the cultured oral mucosal epithelial transplantation (COMET) technique has been most widely reported . Use of this tissue allows treatment of patients with Stevens‐Johnson syndrome . The success rate for COMET is comparable to CLET, resulting in reepithelialization in 63% (n = 230) of reported cases and improved visual acuity in 68% (n = 202) …”

“…The CLET and COMET techniques address this challenge but require production of cultured sheets in a good manufacturing practice‐regulated laboratory, which is expensive and limits accessibility. The COMET technique is promising, but peripheral neovascularization following surgery has been reported in many cases . The use of anti‐angiogenic agents in concert with COMET has shown benefit.…”

“…The COMET technique is promising, but peripheral neovascularization following surgery has been reported in many cases. 16 The use of antiangiogenic agents in concert with COMET has shown benefit. However, inhibition of vascular endothelial growth factor has been shown to affect the overall wound healing response and induce corneal melt.…”