Journal List > J Korean Ophthalmol Soc > v.49(7) > 1008030

J Korean Ophthalmol Soc. 2008 Jul;49(7):1177-1182. Korean.
Published online July 20, 2008.  https://doi.org/10.3341/jkos.2008.49.7.1177
Copyright © 2008 The Korean Ophthalmological Society
A Case of Ocular Surface Reconstruction Using Nasal and Oral Mucosa Autograft
Seok Hyun Lee, M.D., Jae Hoon Kim, M.D., Jee Taek Kim, M.D., Yeoun Sook Chun, M.D., Ph.D. and Jae Chan Kim, M.D., Ph.D.
Department of Ophthalmology, College of Medicine Chung-Ang University, Seoul, Korea.

Address reprint requests to Jae Chan Kim, M.D., Ph.D. Department of Ophthalmology, College of Medicine, Chung-Ang University Yongsan Hospital #65-207 Hangangro 3-Ga, Yongsan-gu, Seoul 140-757, Korea. Tel: 82-2-748-9838, Fax: 82-2-6381-9838, Email: jck50ey@kornet.net
Received September 28, 2007; Accepted January 23, 2008.

Abstract

Purpose

To report a case of ocular surface reconstruction using nasal and oral mucosa auto grafts on a man whose ocular surface was deformed by a chemical burn.

Case summary

A 48-year-old man was injured when his right eye was exposed to alkali solution. He underwent fifteen operations, including amniotic membrane auto grafts and fornix reconstructions. However, his right eye still suffered from symble pharon, drying, corneal neovascularization, and erosion. We performed ocular surface reconstruction with free autologous nasal and oral mucosal transplantation and amniotic membrane graft. By one month after surgery, his eye showed no evidence of symble pharon or fibrovascularization recurrence on the cornea or conjunctiva. By six months after surgery, his ocular surface had stabilized.

Conclusions

Ocular surface reconstruction with free autologous nasal and oral mucosal transplantation is a useful method on eyes that are injured by chemical burns.

Keywords: Chemical burn; Nasal mucosa; Ocular surface reconstruction; Oral mucosa

Figures


Figure 1
The eye with upper and lower symblepharon, fibrovascular tissue on the cornea and conjunctiva, the total limbal deficiency.
Click for larger image


Figure 2
At one month after surgery. (A) There was well formed conjunctival sac without recurrence of symblepharon. (B) There was no corneal epithelium defect.
Click for larger image


Figure 3
Conjunctival biopsy stained with periodic acid-Schiff (×400), (A) Pre-operative biopsy shows squamous metaplasia. (B) At one month after surgery, conjunctival biopsy shows mucin secreting goblet cells. (arrow)
Click for larger image


Figure 4
At six months after surgery, (A) His ocular surface was stabilized without recurrence of symblepharon. (B) Mucin secretion at part of nasal mucosa autotransplantation.
Click for larger image


Figure 5
Nasal mucosa stained with periodic acid-Schiff (×100). Numerous epithelial and submucosal goblet cells. (arrow)
Click for larger image


Figure 6
Oral mucosa stained with periodic acid-Schiff (×100). No goblet cell at epithelium.
Click for larger image

References
1. Goo YM, Chung EH. Autologous limbal transplantation for the treatment of chemical and thermal burn of the cornea. J Korean Ophthalmol Soc 1994;35:202–211.
2. Park DW, Yoo KW, Park WC. The effects of amniotic membrane ointment on corneal alkali burn in rabbits. J Korean Ophthalmol Soc 2002;43:1758–1766.
3. Ha SW, Kim JS, Cheong TB, Kim JC. Therapeutic effect of amniotic membrane extract on keratitis following corneal alkali burn. J Korean Ophthalmol Soc 2001;42:1555–1561.
4. Wenkel H, Rummelt V, Naumann GO. Long term results after autologous nasal mucosal transplantation in severe mucus deficiency syndromes. Br J Ophthalmol 2000;84:279–284.
5. Lee SW, Kim HK, Kim KS, Kang JH. Clinical feature of chemical corneal injuries. J Korean Ophthalmol Soc 2005;46:1447–1453.
6. Ballen PH. Mucous membrane grafts in chemical (lye) burns. Am J Ophthalmol 1963;55:302–312.
7. Gipson IK, Geggel HS, Spurr-Michaud SJ. Transplant of oral mucosal epithelium to rabbit ocular surface wounds in vivo. Arch Ophthalmol 1986;104:1529–1533.
8. Tejwani S, Kolari RS, Sangwan VS, Rao GN. Role of amniotic membrane graft for ocular chemical and thermal injuries. Cornea 2007;26:21–26.
9. Daya SM, Ilari FA. Living related conjunctival limbal allograft for the treatment of stem cell deficiency. Ophthalmology 2001;108:133–134.
10. Kwitko S, Mainho D, Barcaro S, et al. Allograft conjunctival transplantation for bilateral ocular surface disorders. Ophthalmology 1995;102:1020–1025.
11. Manner GE, Mathers WD, Wolfley DE, Martinez JA. Hard-palate mucosa graft in Stevens-Johnson syndrome. Am J Ophthalmol 1994;118:786–791.
12. Fry TL, Wood CI. Readily available full-thickness mucous membrane graft. Arch Otolaryngol Head Neck Surg 1987;113:770–771.
13. Inatomi T, Spurr-Michaud S, Tisdale AS, et al. Expression of secretory mucin genes by human conjunctival epithelia. Invest Ophthalmol Vis Sci 1996;37:1684–1692.
14. Kim JC, Tseng SC. Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 1995;14:472–484.
15. Tsubota K, Goto E, Fujita H, et al. Treatment of dry eye by autologous serum application in Sjögren's syndrome. Br J Ophthalmol 1999;83:390–395.
16. Goto E, Shimmura S, Shimazaki J, Tsubota K. Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea 2001;20:807–810.