Simple oral mucosal epithelial transplantation (SOMET) for bilateral limbal stem cell deficiency in a patient of failed simple limbal epithelial transplantation (SLET): a case report.

INTRODUCTION: We report the successful outcome of cataract surgery following simple oral mucosal epithelial transplantation (SOMET) in a patient with drug-induced cicatrizing conjunctivitis (DICC) and failed simple limbal epithelial transplantation (SLET). While SOMET has previously been described in Stevens-Johnson syndrome, its utility in cases of failed SLET or DICC has not been reported. Additionally, the long-term outcomes of SOMET and subsequent cataract surgery post SOMET have also not been described previously.

CASE PRESENTATION: A male in his thirties presented with bilateral limbal stem cell deficiency (LSCD) secondary to DICC. He initially underwent bilateral allogeneic SLET; however, progressive failure resulted in total corneal conjunctivalization. The patient subsequently underwent SOMET with ocular surface reconstruction in the right eye. At the 1-year follow-up, cataract surgery was performed. At the final follow-up, the patient achieved an unaided visual acuity of 20/40.

DISCUSSION: Drug inducted cicatrising conjunctivitis is a significant cause of bilateral LSCD and conjunctival cicatrization. Although SLET has shown promising results in unilateral LSCD, management options for bilateral disease remain limited. SOMET is an autologous procedure that simultaneously addresses LSCD and ocular surface cicatrization. It combines the advantages of cultivated oral mucosal epithelial transplantation and SLET, and is a single-stage procedure, avoiding the need for laboratory-based cell cultivation, allogeneic tissue, and systemic immunosuppression.

CONCLUSION: SOMET appears to be a feasible option for bilateral LSCD, including cases of failed SLET. This case additionally demonstrates that SOMET can provide long-term ocular surface stability sufficient for successful cataract surgery and meaningful visual rehabilitation.