Transplantation of cultivated autologous oral mucosal epithelial cells in patients with severe ocular surface disorders

Abstract

Background/aims: To determine outcomes of transplants of cultivated autologous oral epithelial cells in patients with severe ocular surface disorders.

Methods: The eyes (n = 6) of four patients with Stevens-Johnson syndrome (three eyes) or chemical burns (three eyes) were studied. Autologous oral epithelial cells, grown for 2-3 weeks on a denuded amniotic membrane carrier in the presence of 3T3 fibroblasts, were air lifted. The resultant sheet was transplanted onto the damaged eye, and acceptance of the sheet by the corneal surface was confirmed 48 hours after surgery. The success of ocular surface reconstruction, graft survival, changes in visual acuity, and postoperative complications were assessed and the quality of the cultivated oral epithelial sheet was evaluated histologically.

Results: At 48 hours after transplant, the entire corneal surface of all six eyes was free of epithelial defects indicating complete survival of the transplanted oral epithelium. Visual acuity was improved in all eyes. During follow up (mean 13.8 (SD 2.9) months), the corneal surface remained stable, although all eyes manifested mild peripheral neovascularisation.

Conclusions: Autologous oral epithelial cells grown on denuded amniotic membrane can be transplanted to treat severe ocular surface disorders.

Figure 1

Cultivation of oral epithelium on amniotic membrane. Light micrographs of cross sections of (A) epithelial cells from oral biopsy samples of patient 2 cultivated on amniotic membrane and (B) normal corneal epithelial cells stained with haematoxylin and eosin. The arrow in (A) points to the denuded amniotic membrane; the arrowhead identifies the membrane of the culture insert (original magnification ×400). (C) The culture insert retained its transparency as indicated by the translucence of the blue cap beneath the culture insert. (D) The cultured oral epithelial cells are immunohistochemically stained for keratin 3 (green). Their nuclei are positive for propidium iodide (red).

Figure 2

Transplantation to a patient with chemical burns of autologous oral epithelial cells cultivated on amniotic membrane (patient 1). Representative slit lamp photographs taken before transplantation without (A) and with fluorescein (B). The photographs in (C–F) were taken 48 hours after transplantation and are without (C) and with fluorescein (D), (E–F) were obtained at the last follow up visit without (E) and with fluorescein (F). Before transplantation, the eye manifested persistent epithelial defects surrounded by inflammatory subconjunctival fibrosis. At 48 hours post-transplantation, the ocular surface was covered with transplanted cells. At the last follow up visit, the corneal surface was stable without defects.

Figure 3

Transplantation to a patient with SJS of autologous oral epithelial cells cultivated on amniotic membrane (patient 4). Representative slit lamp photographs taken before transplantation without (A) and with fluorescein (B). The photographs in (C–D) were taken at the last follow up visit without (C) and with fluorescein (D). Before transplantation, the eye manifested inflammatory subconjunctival fibrosis with neovascularisation, conjuntivalisation, and severe symblepharon. At the last follow up visit, the corneal surface was stable without defects.