Oral Mucosal Grafting in Ophthalmology

Abstract

The ocular surface is a complex functional unit consisting of the eyelids, tear film, conjunctiva, and cornea. Any damage to one of these components can result in ocular surface dysfunction and jeopardize the integrity of the ocular surface or corneal clarity. When medical therapy fails to promote repopulation of the damaged or lost ocular surface tissue, surgical intervention must be considered. One of the best grafts to support the corneal surface or replace the conjunctiva in different ocular surface reconstruction procedures is the oral mucosa. The oral mucosa is a keratinized or nonkeratinized stratified squamous epithelium with a highly vascular lamina propria. There are many advantages that make it optimal for ocular surface reconstruction. Minimal contraction, not having hair follicles, high resistance to microbial agents, barrier to microbial invasion, and rapid healing are among them. This chapter discusses different types of oral mucosal grafts (OMGs), including buccal mucosa-based OMG, labial mucosa-based OMG, and lingual mucosa-based OMG. The chapter will also explain the procedure and complications of oral mucosal grafting. Persistent pain and wound contracture at the donor site-causing inversion of the lip vermilion, numbness in the cheek and lip, parotid duct injury, graft shrinkage or contracture, graft necrosis, mucosal overgrowth, and excessive mucosal secretions-are among the most common complications. OMGs have been used for different purposes in ophthalmology, including symblepharon release and fornix reconstruction when near-total lack of healthy conjunctiva exists. OMG has also been utilized to cover large conjunctival defects in recurrent pterygium surgery with conjunctival scarring and fornix shortening, to cover an exposed glaucoma tube or buckle in scarred conjunctiva. It can also be used to expand the contracted conjunctival socket and help to fit a prosthesis after enucleation. In osteo-odonto-keratoprosthesis, OMGs have been used for ocular resurfacing and in conjunctivodacryocystorhinostomy (CDCR) to line the tract and obviate channel closure. All these applications of OMGs will be discussed in this chapter.