Phenotypic characterization in long-term follow-up of patients with severe ocular surface diseases after autologous cultivated oral mucosal epithelial transplantation

Session Details

Session Title: Presented Poster Session: Surgical Cornea

Venue: Poster Village: Pod 2

First Author: : A.Jiravarnsirikul THAILAND

Co Author(s): :    P. Tanthuvanit   C. Chirapapaisan   P. Ekpo   M. Uiprasertkul   P. Ngowyutagon   W. Pinitpuwadol        

Abstract Details

Purpose:

Cultivated oral mucosal epithelial transplantation (COMET) is an effective surgical technique for reconstruction of severe ocular surface diseases in patients with bilateral limbal stem cell deficiency (LSCD). However, there are limited data on the epithelial phenotype of the cornea after COMET in the long-term period. In this study, we analyzed the cellular phenotype of the cornea in post-COMET patients over the long-term follow up period using impression cytology (IC) with immunofluorescence staining and in vivo confocal microscopy (IVCM). Corneal buttons in patients who underwent penetrating keratoplasty after COMET were also studied for cellular phenotype using immunohistochemistry.

Setting:

Department of Ophthalmology, department of Immunology and department of Pathology, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand.

Methods:

In this cross-sectional study, 13 eyes of 13 patients who were diagnosed as unilateral or bilateral LSCD and underwent COMET at least one year were recruited. Clinical outcome evaluation by slit-lamp microbioscopy ,IVCM and IC were performed. Two IC specimens were collected in 2 consecutive follow-up visits and were analyzed using immunofluorescence staining (cytokeratin(CK) 3, 7, 12). Corneal buttons in patients who underwent PKP after COMET were also analyzed using immunohistochemistry assay (CK3, CK6, CK7, CK12, PAX-6, p63, ZO-1 and integrin beta-1).

Results:

The mean patient age was 51.2 ± 20.6 years. The mean follow-up time after COMET was 78.7 ± 16.3 months (range 50-99 months). There were six eyes with clinical success (no central neovascularization) showed corneal epithelial phenotype or mixed corneal-oral mucosal phenotypes in either IC or IVCM. Seven eyes with clinical failure (presence of central neovascularization), IC showed total or predominant conjunctival phenotype and total or predominant oral mucosal phenotype was also observed. Immunohistochemistry analysis from corneal button in clinically successful patient who underwent PKP after COMET showed positive for corneal, oral mucosal and stem cells markers.

Conclusions:

In long term follow-up, COMET can restore ocular surface damage in patients with clinically successful thus suggesting that oral mucosal epithelial cells can transdifferentiate into cornea-like epithelial cells. In clinically failed patients, oral mucosal epithelial cells were phenotypically detected on the ocular surface by IC and IVCM, suggesting that the autologous cultivated oral epithelial cells existed on the corneal surface but these cells cannot maintained their stemness and thus were invaded by conjunctival cells.

Financial Disclosure:

None