Oral mucosal graft with amniotic membrane transplantation for total limbal stem cell deficiency

Am J Ophthalmol. 2011 Nov;152(5):739-47.e1. doi: 10.1016/j.ajo.2011.03.037. Epub 2011 Jul 30.


Purpose: To report the results of oral mucosal graft for reconstruction of corneas with total limbal stem cell deficiency.

Design: Retrospective, interventional case series.

Methods: Seven patients (7 eyes) with total limbal stem cell deficiency caused by chemical burn (4 eyes), Stevens-Johnson syndrome / toxic epidermal necrolysis (1 eye), ocular cicatricial pemphigoid (1 eye), and multiple cryotherapies and application of mitomycin C for conjunctival melanoma (1 eye) were enrolled in this study. Oral mucosal graft was transplanted as a surrogate limbus together with amniotic membrane transplantation with a follow-up of at least 8 months. Symptomatic relief, restoration of a stable epithelium, corneal clarity, and the best-corrected visual acuity were assessed.

Results: Limbal stem cell deficiency was confirmed by impression cytology in all eyes, among which 6 were bilateral while 1 was unilateral. All 7 patients presented with severe loss of vision, photophobia, pain, chronic inflammation, and corneal vascularization and scarring. For 30 ± 19.8 months, pain and photophobia were resolved in all 7 eyes; 6 eyes exhibited a stable epithelium with regressed corneal vascularization and reduced chronic inflammation. Visual acuity was improved in all 7 eyes. One eye developed partial limbal stem cell deficiency due to exposure at 47 months follow-up and was reoperated. Five eyes had peripheral corneal vascularization.

Conclusions: Oral mucosal graft is a viable alternative for treating total limbal stem cell deficiency in eyes where transplantation of allogeneic limbal stem cells has failed or is not feasible.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amnion / transplantation*
  • Corneal Diseases / etiology
  • Corneal Diseases / physiopathology
  • Corneal Diseases / surgery*
  • Epithelium, Corneal / pathology
  • Female
  • Humans
  • Limbus Corneae / pathology*
  • Male
  • Middle Aged
  • Mouth Mucosa / transplantation*
  • Retrospective Studies
  • Stem Cells / pathology*
  • Treatment Outcome
  • Visual Acuity / physiology
  • Wound Healing / physiology
  • Young Adult