• Written By: Shimon Rumelt, MD

    This retrospective study found that cultivated oral mucosal epithelial sheet transplantation (COMET) can substantially improve vision in patients with complete limbal stem cell deficiency (LSCD).

    Subjects were 40 patients (46 eyes) with complete LSCD who underwent COMET for visual improvement. Their LSCD disorders were: Stevens-Johnson syndrome (21 eyes), ocular cicatricial pemphigoid (10 eyes), thermal or chemical injury (seven eyes), or other diseases (eight eyes). Preoperative visual acuity was counting fingers or hand movements in more than half of the eyes.

    Patients with Stevens Johnson syndrome showed a significant improvement in BCVS by the 24th postoperative week, while those with ocular cicatricial pemphigoid, thermal or chemical injuries, or other diseases, did not, despite improvement in total ocular surface grading score.

    Although postoperative persistent epithelial defects occurred in 16 patients and slight to moderate corneal infection in two patients, all of them were treated successfully with no eye perforation or vision loss. The authors write that considering that most of the eyes in this study were at the end stage of a severe ocular surface disease, these results are very favorable and encouraging.

    While there was improvement in visual acuity following the procedure, the follow-up period of 24 weeks was relatively short and many patients underwent additional procedures, such as amniotic membrane transplantation. Furthermore, the authors did not explain the improvement in visual acuity, which would only be expected with the development of a new transparent corneal epithelium. They also did not report the exact inclusion and exclusion criteria. It would have also been interesting to know which procedures the patients underwent before this one and whether concurrent use of anti-metabolites would have a beneficial effect.