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Leonard P. K. Ang, FRCS, MRCOphth; Takahiro Nakamura, MD, PhD; Tsutomu Inatomi, MD, PhD; Chie Sotozono, MD, PhD; Noriko Koizumi, MD, PhD; Norihiko Yokoi, MD, PhD; Shigeru Kinoshita, MD, PhD

Arch Ophthalmol. 2006;124:1543-1551.

Objective  To evaluate the use of autologous serum (AS)–derived cultivated oral epithelial transplants for the treatment of severe ocular surface disease.

Methods  We used AS from 10 patients with severe ocular surface disease and total limbal stem cell deficiency to develop autologous cultivated oral epithelial equivalents. These were compared with epithelial equivalents derived from conventional fetal bovine serum–supplemented medium. Surgery involved removal of the corneal pannus and surrounding diseased tissue and transplantation of the AS-derived epithelial equivalents. The oral equivalents were analyzed by review of histologic and immunohistochemical findings.

Results  Oral epithelial sheets cultivated in AS- and fetal bovine serum–supplemented media were similar in morphology, and both formed basement membrane assembly proteins important for maintaining graft integrity. Complete corneal epithelialization was achieved within 2 to 5 days postoperatively. The ocular surface remained stable without major complications in all eyes during a mean ± SD follow-up of 12.6 ± 3.9 months. The visual acuity improved by more than 2 lines in 9 of 10 eyes, with transplanted oral epithelium surviving up to 19 months.

Conclusion  The successful use of an AS-derived oral epithelial equivalent to treat severe ocular surface disease represents an important advance in the pursuit of completely autologous xenobiotic-free bioengineered ocular equivalents for clinical transplantation.

Author Affiliations: Department of Ophthalmology, Kyoto Prefectural University of Medicine (Drs Ang, Nakamura, Inatomi, Sotozono, Koizumi, Yokoi, and Kinoshita), and Research Center for Regenerative Medicine, Doshisha University (Drs Nakamura and Koizumi), Kyoto, Japan; and Singapore National Eye Centre (Dr Ang).