BACKGROUND: Ocular trauma or disease may lead to severe corneal opacification and, consequently, severe loss of vision as a result of complete loss of corneal epithelial stem cells. Transplantation of autologous corneal stem-cell sources is an alternative to allograft transplantation and does not require immunosuppr ession, but it is not possible in many cases in which bilateral disease produces total corneal stem-cell deficiency in both eyes. We studied the use of autolog ous oral mucosal epithelial cells as a source of cells for the reconstruction of the corneal surface. METHODS: We harvested 3-by-3-mm specimens of oral mucos al tissue from four patients with bilateral total corneal stem-cell deficiencie s. Tissue-engineered epithelial-cell sheets were fabricated exvivo by culturin g harvested cells for two weeks on temperature responsive cell-culture surfaces with 3T3 feeder cells that had been treated with mitomycin C. After conjunctiva l fibrovascular tissue had been surgically removed from the ocular surface, shee ts of cultured autologous cells that had been harvested with a simple reducedtem perature treatment were transplanted directly to the denuded corneal surfaces (o ne eye of each patient) without sutures. RESULTS: Complete reepithelialization o f the corneal surfaces occurred within one week in all four treated eyes. Cornea l transparency was restored and postoperative visual acuity improved remarkably in all four eyes. During a mean follow-up period of 14 months, all corneal surf aces remained transparent. There were no complications. CONCLUSIONS: Sutureless transplantation of carrier-free cell sheets composed of autologous oral mucosal epithelial cells may be used to reconstruct corneal surfaces and can restore vi sion in patients with bilateral severe disorders of the ocular surface.
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