Simple Oral Mucosal Epithelial Transplantation for Bilateral Limbal Stem Cell Deficiency in Congenital Aniridia

To describe the surgical approach and postoperative outcome of simple oral mucosal epithelial transplantation (SOMET) combined with penetrating keratoplasty for congenital aniridia-associated limbal stem cell deficiency (LSCD).

A 61-year-old woman with congenital aniridia, severe bilateral keratopathy, and longstanding visual impairment underwent right-sided combined penetrating keratoplasty, lensectomy with intraocular lens implantation, and modified SOMET using autologous oral buccal mucosal epithelial graft segments. Ocular history included bilateral foveal and optic nerve hypoplasia, nystagmus, and a previously failed right limbal stem cell transplant. Examination demonstrated dense fibrovascular membranes covering both corneas, consistent with advanced LSCD. A review of the literature was also performed to identify prior reports of SOMET or SOMET-like techniques for LSCD.

Oral mucosal grafts harvested from the inner cheek were divided into 6 3-mm grafts and sutured around the limbus, followed by placement of a double-layer amniotic membrane. Postoperatively, the oral mucosal grafts remained adherent with stable epithelialization. Visual acuity improved from hand movements preoperatively to 6/120 unaided at 4 weeks, with maintained ocular surface integrity. Corneal impression cytology at 6 months demonstrated mixed epithelial populations with morphologic features favouring oral mucosal origin. Five prior studies describing SOMET or SOMET-like techniques for LSCD were identified, all reporting favourable anatomical and visual outcomes.

Modified SOMET using direct oral mucosal transplantation is a simplified alternative to cultivated oral mucosal transplantation. To our knowledge, this is the first report describing its use in congenital aniridia with bilateral LSCD.