Long term results after autologous nasal mucosal transplantation in severemucus deficiency syndromes

Aim-Severe mucus deficiency syndromes may require substitution of mucous me mbrane for re-establishment of the ocular surfaces. The long team results a fter autologous nasal mucosal transplantation were investigated. Methods-55 eyes of 50 patients with severe mucus deficiency syndromes were followed retrospectively after free autologous nasal mucosal transplantatio n-group A: patients after severe lye, acid, heat burns, or radiation (n=38 eyes), group B: patients with systemic mucosal disease (n=17 eyes). The res ults of routine clinical examination were recorded and patients were follow ed for a median of 37 months. 17 biopsies of transplanted nasal mucosa were studied by light microscopy and 22 patients by impression cytology before and at several intervals after mucosal transplantation. Results-All nasal mucosal grafts healed well and no intraoperative complica tions occurred. During follow up 107 additional surgical procedures were pe rformed including 16 lamellar and 21 penetrating keratoplasties. Subjective complaints improved in 44/47 patients with preoperative symptoms. Best cor rected visual acuity at the end of follow up was increased in 23 eyes, 10 e yes (18.2%) reached a final visual acuity equal to or greater than 20/200. Histopathologically, all (n=17) biopsies showed vital intraepithelial mucin producing goblet cells in the nasal mucosal graft (median 25 cells/field ( 400x magnification)). The mean density of goblet cells before transplantati on was 48/mm(2) and after nasal mucosal;grafting 432/mm(2) measured by impr ession cytology (p<0.0001). Conclusions-Functional goblet cells persist in autologous nasal mucosa for up to 10 years after transplantation. In patients with severe mucus deficie ncy syndromes of different origin nasal mucosal transplantation can re-esta blish the ocular surface, substitute the mucus components of the tear film, improve symptoms of time patients, and facilitate a moderate increase in v isual acuity.