Barrier function and cytologic features of the ocular surface epithelium after autologous cultivated oral mucosal epithelial transplantation

Objective: To determine the barrier function and cytologic features of ocular surface epithelium after autologous cultivated oral mucosal epithelial transplantation in a prospective observational study. Methods: The status of the epithelium in 4 eyes with limbal stem cell deficiency was studied preoperatively and postoperatively. We used an impression method to determine the cytologic features and anterior fluorophotometry to determine barrier function. Results: Impression cytology showed nonkeratinized, squamous, polygonal, cohesive cells with a low nuclear to cytoplasmic cell ratio and no goblet cells, corresponding to cultivated oral mucosal epithelium, at up to 16 months after surgery. In some cases, the epithelium displayed a mixture of oral mucosal and conjunctival epithelium, especially in cases with a longer postoperative period. Central epithelial permeability remained persistently high throughout the follow-up period, regardless of the epithelial phenotype. Conclusions: Cultivated oral mucosal epithelial cells were observed to survive for more than 1 year after transplantation, with gradual replacement by conjunctival epithelium in some cases. Decreased barrier function of the transplanted epithelium may have prognostic implications, suggesting the presence of oral mucosal epithelium long after surgery.