The clinical efficacy of a new surgical technique of oral mucosal epithelial transplantation for severe ocular surface disorders

Abstract

Abstract Background Sever ocular surface disorder was one of the main blinding diseases. Reconstruction work for this kind of ocular surfaces is difficult due to the lack of original tissues. We developed a new surgical technique to reconstruct the ocular surface by using oral mucosal epithelia as the alternative for the limbus in such kind of eyes since 2011, which we called it oral mucosal epithelial transplantation (OMET). The study was designed to analyze the clinical efficacy for OMET in reconstruction of eyes with severe ocular surface disorder. Methods Retrospective review of patients with severe ocular surface disorder who underwent OMET during 2011 to 2021 at the Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patients who had been followed up for at least 3 months after surgery and had sufficient pre- or postoperative records were included. Surgical efficacy was evaluated by comparing the following pre- and postoperative factors: best-corrected visual acuity, corneal transparency, neovascularization grade and symblepharon grade. Post-operative ocular surface impression cytology results were analyzed to study the morphology of the new corneal epithelial cells. Results Forty-eight patients (49 eyes) with a mean age of 42.55 ± 12.40 years (range, 12–66 years) were enrolled. Injuries included chemical burns (30 eyes), thermal burns (16 eyes), explosive injuries (1 eye), Stevens-Johnson syndrome (1 eye), and multiple pterygiums (1 eye). The mean follow-up period was 25.97 ± 22.99 months (range, 3–94 months). After surgery, 29 eyes (59.18%) had improved corneal transparency, and 26 eyes (53.06%) had improved best-corrected visual acuity. Forty-seven eyes (95.92%) had a stable epithelium, with a mean epithelization time of 26.04 ± 26.43 days. Forty-four eyes (89.80%) had a clearly reduced degree of neovascularization. Of 20 eyes with preoperative symblepharon, 15 (75%) were completely corrected, and 5 (25%) were partially corrected. Impression cytological studies showed that the newly transdifferentiated epithelial cells were morphologically different from the corneal or conjunctival epithelial cells and more like the oral mucosal epithelial cells of their origin. Conclusions OMET was an effective surgical technique for severe ocular surface disorder reconstruction.