Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Ophthalmology. 2011 Aug;118(8):1524-30. doi: 10.1016/j.ophtha.2011.01.039. Epub 2011 May 14.
To evaluate the long-term outcome of cultivated oral mucosal epithelial transplantation (COMET) in treatment of eyes with total limbal stem cell deficiency.
Noncomparative, retrospective, interventional case series.
Forty eyes in 36 patients with total limbal stem cell deficiency (Stevens-Johnson syndrome in 12 eyes, chemical or thermal burns in 11 eyes, ocular cicatricial pemphigoid [OCP] in 9 eyes, pseudo-OCP in 7 eyes, and gelatinous drop-like dystrophy in 1 eye) were treated at the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Cultivated autologous oral mucosal epithelial sheets were transplanted onto the ocular surface in eyes with total limbal stem cell deficiency.
Reconstruction of a stable ocular surface with a clear appearance and no epithelial defects, reduction in fibrovascular tissue invasion of corneal surface, a functional fornix, change in visual acuity, and postoperative complications.
The mean follow-up period was 25.5 months (range, 6-54.9 months). Kaplan-Meier analysis of a corneal surface stability revealed an early decline in transplanted oral mucosal epithelial stability over the first 6 months, remaining comparatively stable thereafter (1 year, 64.8%; 2 years, 59.0%; and 3 years, 53.1%). Postoperative persistent epithelial failure developed within the first 3 months in 9 eyes. Early epithelial failure was associated closely with preoperative corneal defects. Gradual fibrovascular tissue invasion of the corneal surface was observed in 8 eyes and was marked in cases of OCP. Survival of a functional fornix decreased progressively until approximately 6 months. Postoperative visual acuity seemed to be related to the presence of corneal opacity. Complications included stromal melting or perforation in 8 eyes, infectious keratitis in 2 eyes, glaucoma in 8 eyes, and recurrence of herpetic keratitis in 1 eye. Corneal melting or perforation and infectious keratitis were associated closely with persistent epithelial defects after COMET.
The transplantation of cultivated oral mucosal epithelial sheets offers a viable and safe alternative in the reconstruction of a stable ocular surface. Epithelialization of the corneal surface is very important not only in obtaining a satisfactory long-term outcome, but also in achieving a lower incidence of complications.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估培养的口腔黏膜上皮移植（COMET）治疗完全性角膜缘干细胞缺乏症的长期疗效。
非对照、回顾性、干预性病例系列研究。
日本东京齿科大学眼科的 36 名患者（12 只眼为史蒂文斯-约翰逊综合征，11 只眼为化学或热烧伤，9 只眼为眼瘢痕性类天疱疮[OCP]，7 只眼为假性 OCP，1 只眼为胶状滴状营养不良）的 40 只眼接受了治疗。
将培养的自体口腔黏膜上皮片移植到完全性角膜缘干细胞缺乏症的眼表面。
重建稳定的外观清晰的眼表，无上皮缺损，减少角膜表面纤维血管组织侵犯，形成功能性穹窿，视力变化及术后并发症。
平均随访时间为 25.5 个月（6-54.9 个月）。角膜表面稳定性的 Kaplan-Meier 分析显示，移植口腔黏膜上皮的稳定性在最初 6 个月内迅速下降，此后相对稳定（1 年 64.8%；2 年 59.0%；3 年 53.1%）。9 只眼术后持续发生早期上皮失败。早期上皮失败与术前角膜缺陷密切相关。8 只眼出现逐渐的纤维血管组织侵犯角膜表面，在 OCP 病例中较为明显。功能性穹窿的存活率直到大约 6 个月逐渐下降。术后视力似乎与角膜混浊有关。并发症包括 8 只眼的基质融解或穿孔、2 只眼的感染性角膜炎、8 只眼的青光眼和 1 只眼的疱疹性角膜炎复发。角膜融解或穿孔和感染性角膜炎与 COMET 后持续性上皮缺陷密切相关。
培养的口腔黏膜上皮片移植为重建稳定的眼表面提供了一种可行且安全的替代方法。角膜表面的上皮化不仅对获得满意的长期疗效非常重要，而且对降低并发症的发生率也非常重要。
作者在本文讨论的材料中没有任何专有或商业利益。
