Efficacy of Cultivated Oral Mucosal Epithelial Transplantation for Limbal Stem Cell Deficiency in Stevens–Johnson Syndrome Versus Other Etiologies

PURPOSE: The aim of this study was to compare the efficacy and outcomes of cultivated oral mucosal epithelial transplantation (COMET) in limbal stem cell deficiency (LSCD) between patients with Stevens-Johnson syndrome (SJS) and those with other etiologies (non-SJS), evaluated by clinical manifestations and epithelial phenotypes. METHODS: This prospective, comparative study enrolled patients with LSCD who were scheduled for COMET. Preoperative and postoperative assessments were performed using slit-lamp microscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining. Successful outcomes were defined as an intact ocular surface without conjunctivalization and the presence of cornea-like epithelium detected by IVCM and/or immunofluorescence staining at the central cornea. Otherwise, the outcomes were interpreted as failure. Visual improvement and risk factors of COMET failure were analyzed. RESULTS: Eighteen eyes of 18 patients (7 with SJS, 11 non-SJS) were included. The median follow-up time was 15.5 months (range: 13-35 months). The overall success rate was 72.2% (13 eyes: 2 with SJS and 11 non-SJS), which was significantly lower in patients with SJS (28.6%) than in non-SJS patients (100%) (P = 0.002). Among successful cases, 60.2% showed visual improvement while the others (30.8%) remained unchanged. The risk of COMET failure was significantly associated with SJS (P = 0.002), lid margin keratinization (P = 0.023), preoperative symblepharon (P = 0.036), postoperative epithelial defects lasting more than 2 weeks (P = 0.022), and the absence of multilayered cornea-like epithelium detected by IVCM at 6 months postoperatively (P = 0.017). CONCLUSIONS: COMET demonstrates good efficacy and favorable outcomes for LSCD, particularly in non-SJS eyes. While the success rate was excellent in non-SJS patients, the outcomes were significantly limited in those with SJS.