Visual improvement after cultivated oral mucosal epithelial transplantation

Mucous membrane pemphigoid

Mucous membrane pemphigoid (MMP) is chronic and frequently associated with exacerbations and remissions of clinical signs and symptoms. Clinicians should use pathologic and immunonologic techniques to help diagnose patients. Multidisciplinary collaboration is often necessary for the diagnosis and proper treatment of MMP. Systemic adjuvant immunosuppressive therapy is necessary for patients with progressive disease. In spite of the advances in available immunosuppressive medications and biologics, scarring is a significant complication in many cases. Surgical intervention is not curable; however, it may be necessary for restoring function and improving quality of life.

Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis

PURPOSE OF REVIEW

To review the newer, effective ophthalmologic treatments for acute Stevens-Johnson syndrome (SJS) as well as the emerging treatment options for patients with chronic, severe ocular surface damage from the disease.

RECENT FINDINGS

Amniotic membrane transplantation (AMT) applied to the eyes and eyelids in the acute phase of SJS can prevent the devastating scarring and visual problems that characterize the chronic phase of the disease. The severity of ocular inflammation in the acute phase does not always correlate to the severity of skin and systemic involvement. Thus, it is crucial that all patients with SJS be evaluated by an ophthalmologist familiar with the current management of the disease, the potential urgency of the situation and the option of AMT. Although challenging, the severe, chronic ocular problems of SJS can be at least partially alleviated with autologous serum drops, mucous membrane grafting to replace scarred tarsal conjunctiva, specialized contact lenses (PROSE), conjunctival replacement surgery (COMET), limbal stem cell transplantation and kerotoprostheses.

SUMMARY

Early AMT is an effective treatment of acute SJS. Emerging treatments offer increased hope for those who have already suffered damage from SJS, but emphasis on the prevention of damage in the acute phase is most crucial.

Oral mucosal grafts: old technique in new light

PURPOSE

To present an update on indications and efficacy of oral mucosal grafts in the clinical management of ocular surface diseases focusing on the new developments of the last 5 years.

METHODS

Pubmed research on the databases of the years 2007 up to 2012 for the key words mucous membrane graft and eye, fornix reconstruction, eyelid reconstruction, and conjunctival replacement.

RESULTS

Well-documented clinical indications for oral mucosal grafting to the ocular surface include correction of restricted socket syndrome, ocular adnexal reconstruction after tumor resection, cicatricial ocular surface diseases and therapy-refractory pterygia. New indications are conjunctival insufficiency after filtrating glaucoma surgery and the combination of mucosa and amniotic membrane grafting for fornix reconstruction. Moreover, different strategies for ex vivo mucous epithelial cell expansion are under discussion.

CONCLUSIONS

Oral mucosal grafting is a viable option for the replacement of the conjunctiva. Advantages include easily accessibility of grafts in sufficient size even for repeated procedures and a high stability of the grafts. On the other hand, nasal mucosal grafts are superior for some indications due to the lack of goblet cells in the oral mucosa.