Ocular Surface Reconstruction With Autologous Nasal Mucosa in Cicatricial Ocular Surface Disease
Accepted 22 July 2009. published online 28 October 2009.
Purpose
To investigate the possibility of replacing the metaplastic ocular surface with nasal mucosa, and to evaluate the results of autologous nasal and oral mucosal transplantation in cicatricial ocular surface diseases.
Design
Retrospective interventional case series.
Methods
We studied 6 eyes in 6 patients with chemical burns, which were characterized by a cicatricial ocular surface. After removal of cicatricial tissues and symblepharolysis, autologous nasal mucosa was transplanted in all patients. In 3 patients with extensive damage, oral mucosal autografting was performed concurrently. The nasal and oral mucosa was evaluated using immunohistochemical analysis for p63, K3, MUC5AC, and CD34. Clinical outcomes were assessed based on visual acuity, ocular manifestations, and liquid-based cytology.
Results
Immunohistochemical analysis revealed a plentitude of p63 and K3 in nasal mucosal epithelium. Goblet cells and MUC5AC expression were only observed in nasal mucosal epithelium, not in oral mucosal epithelium. Well-developed parallel vasculature was demonstrated in the nasal mucosa. In contrast, perpendicular vasculature was demonstrated in the oral mucosa. This vascular feature remained after transplantations. In all patients, ocular surface stability recovered with no major complications and increased goblet cells were observed on ocular surface. However, delayed epithelialization and ischemic thinning were seen at oral mucosal graft sites.
Conclusions
Nasal mucosa, which has the advantage of well-developed parallel vasculature, enriched goblet cells, and plenty of stem cells, may be an ideal substitute for a cicatricial ocular surface. Transplantation of autologous nasal mucosa is a very effective method for achieving ocular surface reconstruction in cicatricial ocular surface diseases.
aDepartment of Ophthalmology, College of Medicine, Chung-Ang University, Yongsan Hospital, Seoul, Republic of Korea
bDepartment of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Chung-Ang University, Yongsan Hospital, Seoul, Republic of Korea
cResearch and Development Institute, Modern Cell and Tissue Technologies Incorporated, Seoul National University of Technology, Seoul, Republic of Korea
dDepartment of Genetic Engineering, College of Life Science, Kyung Hee University, Gyeonggi-do, Republic of Korea
Inquiries to Jae Chan Kim, Department of Ophthalmology, Chung-Ang University, Yongsan Hospital, 65-207, Hangangro-3Ga, Yongsan-Gu, Seoul 140-757, Republic of Korea
ABSTRACT