Recently at ISEC, Dr KY Then have succesfully performed a novel procedure: cultivated oral mucosa epithelial transplantation (COMET) followed by DALK on a patient with limbal stem cells deficiency. The patient had severe 4 chemical injury and was blind in both eyes. The procedure consists of 3 stages.

First stage involved harvesting the buccal mucosa from the oral cavity, and the mucosa was grown in the lab over 6 weeks on amniotic membrane and then onto a cell sheet. Cellular differentiation into epithelial cells is done using air-liquid lifting.

The second procedure involves removing the conjunctival tissue from the cornea, followed by cell sheet transplantation.

The third stage is a Deep Lamellar Keratoplasty (DALK) procedure, as the patient also has corneal stromal scarring.

3 weeks following DALK, we had a very happy patient, who could see 6/15 on the vision chart. This procedure is the first in Malaysia and ISEC is one of three centres in Asia Pacific to be able perform this procedure. The procedure is Only suitable for patients with severe anterior segment scarring but still possesses good tear film.

If the surface is dry, then another complex procedure, Osteo-Odonto-Keratoprosthesis (OOKP) may be considered.

Dr Then is also currently the second surgeon in Asia that performs successful OOKP procedures.

1. Pre-operation: Severe corneal scarring
2. Pre-operation: Staining of corneal abrasion
3. Post-operation: Clear corneal transplant