Purpose: The aim of this study was to report four cases of limbal stem cell deficiency in which oral antifungal therapy enabled successful generation of cultured oral mucosal epithelial sheets for ocular surface reconstruction. Methods: This case series included two patients with Stevens–Johnson syndrome and two with ocular cicatricial pemphigoid, all of whom were scheduled for cultivated oral mucosal epithelial transplantation (COMET). Initial oral mucosal biopsies resulted in fungal contamination during cell culture. Patients subsequently underwent targeted oral management, including dental cleaning, cessation of denture use, and antifungal therapy. Results: All four patients (age range: 45–91 years) exhibited Candida albicans contamination in the primary cultures. After careful oral management, including oral hygiene, denture discontinuation, and oral amphotericin B syrup, the second biopsies were performed with uncontaminated cultures. Autologous COMET sheets were successfully generated and transplanted in all cases, resulting in improved ocular surface stability without postoperative infectious complications. Conclusions: This case series emphasizes the importance of preoperative dental assessment and oral antifungal treatment in preventing microbial contamination during epithelial sheet preparation for COMET.
Kitazawa et al. (Tue,) studied this question.