Ocular Surface Reconstruction Using Circumferentially-trephined Autologous Oral Mucosal Graft Transplantation in Limbal Stem Cell Deficiency
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Purpose: To investigate the effects of transplantation of a circumferentially-trephined autologous oral mucosalgraft using a vacuum trephine on ocular surface reconstruction in patients with limbal stem cell deficiency. Methods: Patients with a limbal stem cell deficiency who underwent transplantation of autologous oral mucosalgraft performed by a particular surgeon in Seoul National University Hospital were included. The medical recordsof these five patients were retrospectively reviewed. The lower labial mucosal graft inside the inferior lipwas trephined to a depth of 250 μm using a donor vacuum trephine with a 9-mm diameter. Outside markingswere made using a 14-mm intraoperative keratometer. The oral mucosal graft was dissected under a microscopeusing a Beaver mini-blade as either a ring or a crescent-shaped strip with a 5-mm width. The mucosalgraft was transplanted onto the limbus in the limbal-deficient eye. Best-corrected visual acuity and cornealstatus were measured during the follow-up period. Results: Four patients were diagnosed with Stevens-Johnson syndrome and one was diagnosed with atopy-associatedimmune keratitis. The mean follow-up period was 10.4 ± 2.9 months. After 4 months, visual acuityimproved in all patients, and the mean improvement in logarithm of the minimum angle of resolution visualacuity was 0.526 ± 0.470 (range, 0.15 to 1.10). Corneal surface erosion and neovascularization decreased infour patients, and stromal opacity decreased in two patients. The engraftments maintained ocular surface stabilizationin four of the five patients at the last follow-up. Conclusions: Transplantation of circumferential autologous oral mucosal grafts may be effective for the treatmentof limbal stem cell deficiency.
Abstract
Purpose: To investigate the effects of transplantation of a circumferentially-trephined autologous oral mucosalgraft using a vacuum trephine on ocular surface reconstruction in patients with limbal stem cell deficiency. Methods: Patients with a limbal stem cell deficiency who underwent transplantation of autologous oral mucosalgraft performed by a particular surgeon in Seoul National University Hospital were included. The medical recordsof these five patients were retrospectively reviewed. The lower labial mucosal graft inside the inferior lipwas trephined to a depth of 250 μm using a donor vacuum trephine with a 9-mm diameter. Outside markingswere made using a 14-mm intraoperative keratometer. The oral mucosal graft was dissected under a microscopeusing a Beaver mini-blade as either a ring or a crescent-shaped strip with a 5-mm width. The mucosalgraft was transplanted onto the limbus in the limbal-deficient eye. Best-corrected visual acuity and cornealstatus were measured during the follow-up period. Results: Four patients were diagnosed with Stevens-Johnson syndrome and one was diagnosed with atopy-associatedimmune keratitis. The mean follow-up period was 10.4 ± 2.9 months. After 4 months, visual acuityimproved in all patients, and the mean improvement in logarithm of the minimum angle of resolution visualacuity was 0.526 ± 0.470 (range, 0.15 to 1.10). Corneal surface erosion and neovascularization decreased infour patients, and stromal opacity decreased in two patients. The engraftments maintained ocular surface stabilizationin four of the five patients at the last follow-up. Conclusions: Transplantation of circumferential autologous oral mucosal grafts may be effective for the treatmentof limbal stem cell deficiency.
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