Abstract
Purpose: To report a case series of seven eyes (six patients) with severe limbal stem cell failure who underwent cultivated oral mucosa epithelium transplantation (COMET) in preparation for corneal transplant surgery and assess the change in visual acuity postoperatively.
 Design: Case series.
 Methods: A retrospective analysis of an interventional case series of six patients with severe limbal stem cell deficiency who underwent COMET between 2012 and 2015 was performed. Six eyes had COMET followed by corneal transplant, and one eye had corneal transplant preceding COMET. The change in the visual acuity after operation was evaluated.
 Results: A total of six patients with seven eyes were studied. All of them had severe ocular surface disease with limbal stem cell deficiency (LSCD) secondary to chemical injury (five eyes), SJS (one eye), and severe ocular rosacea (one eye). Four eyes had improvements in visual acuity, two of which achieved best corrected visual acuity (BCVA) of 6/12.
 Conclusion: The use of COMET helps to optimize the ocular surface in severe LSCD for further corneal transplant surgeries. It has helped to improve the graft uptake and subsequent visual improvement, especially in chronic chemical burn cases.
Highlights
Limbal stem cells are essential for maintaining the transparency and clarity of the cornea, as these cells are self-regenerating and allow renewal of the cornealWhen limbal stem cells are damaged, there will be migration of conjunctiva epithelial cells to the ocular surface, causing neovascularization and loss of corneal clarity
We report six cases of clinically evident severe limbal stem cell deficiency (LSCD) who underwent cultivated oral mucosa epithelium transplantation COMET: four cases of chemical injury, one case of Stevens-Johnson syndrome (SJS), and one of acne rosacea, respectively
He was completely blind in the right eye and had counting finger vision in the left eye
Summary
Limbal stem cells are essential for maintaining the transparency and clarity of the cornea, as these cells are self-regenerating and allow renewal of the corneal. When limbal stem cells are damaged, there will be migration of conjunctiva epithelial cells to the ocular surface, causing neovascularization and loss of corneal clarity. The causes of LSCD can be generally divided into primary or congenital, such as aniridia and ectodermal dysplasia, and secondary or acquired, such as chemical injury, Stevens-Johnson syndrome (SJS), and ocular cicatricial pemphigoid.[1] We report six cases of clinically evident severe LSCD who underwent cultivated oral mucosa epithelium transplantation COMET: four cases of chemical injury, one case of SJS, and one of acne rosacea, respectively. Their best corrected postoperative visual acuity was evaluated
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