{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T20:09:24Z","timestamp":1770062964679,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cultivated oral mucosal epithelial transplantation (COMET\/CAOMECS) is an autologous, immunosuppression-sparing option for ocular surface reconstruction in limbal stem cell deficiency (LSCD). After two decades, indications, platforms and outcome definitions vary, and COMET\u2019s position relative to limbal-derived epithelium remains uncertain. Methods: We conducted a PRISMA-ScR scoping review of human clinical studies (PubMed, 2000\u201330 December 2025) with hand-searching and regulatory sources. Eligible reports included COMET\/CAOMECS series and comparative cohorts (CLET\/ACLET, SLET, KLAL\/CLAL). The primary outcome was anatomical success (stable epithelialised cornea without recurrent persistent epithelial defect, progressive conjunctivalisation or uncontrolled neovascularisation at last assessment). Given heterogeneity in definitions and analytic frames (fixed-time vs. Kaplan\u2013Meier [KM]), results were synthesised narratively by indication and platform. Results: Twenty-five reports (893 eyes; 821 patients) were included. Aetiologies were predominantly burns and SJS\/TEN. Across amniotic membrane-based mixed-aetiology series, 12-month anatomical success clustered around 55\u201370%. Aggregated descriptively across COMET eyes, 211\/467 (45%) had a stable surface at last follow-up. Epithelialisation was generally rapid in quiet AM-based reconstructions and slower with severe adnexal disease or carrier-free platforms. Mean BCVA improved from 1.8 \u00b1 0.7 to 1.4 \u00b1 0.7 logMAR (471 eyes); \u22652-line gains occurred in 308\/471 (65.4%). A matched comparison suggested better 12-month survival, less neovascularisation and better BCVA with substrate-free versus AM-carried COMET; a biomaterial-\/feeder-free platform reconstructed most eyes but failed more often with four-quadrant symblepharon. Observational comparative cohorts suggested higher surface survival and average visual gain with limbal-derived epithelium, at the cost of systemic immunosuppression. Conclusions: In appropriately selected bilateral LSCD, COMET offers immunosuppression-sparing reconstruction with moderate, durable surface stability and clinically meaningful visual gains when performed on a quiet, optimised surface. Platform refinements\u2014particularly substrate-free constructs\u2014and prospective, indication-defined comparative studies with harmonised outcomes are needed to define COMET\u2019s role relative to limbal-derived epithelium.<\/jats:p>","DOI":"10.3390\/jcm15031134","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:00:33Z","timestamp":1770022833000},"page":"1134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cultivated Oral Mucosal Epithelial Transplantation for Limbal Stem Cell Deficiency: A Scoping Review of Indications, Platforms, Outcomes and Safety"],"prefix":"10.3390","volume":"15","author":[{"given":"Konstantinos","family":"Papadopoulos","sequence":"first","affiliation":[{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Elalfy","sequence":"additional","affiliation":[{"name":"Corneoplastic Unit, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK"},{"name":"The Research Institute of Ophthalmology, Cairo 3725102, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7668-3168","authenticated-orcid":false,"given":"Hasan","family":"Naveed","sequence":"additional","affiliation":[{"name":"Corneoplastic Unit, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sokratis","family":"Zormpas","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4242-8983","authenticated-orcid":false,"given":"Artemis","family":"Matsou","sequence":"additional","affiliation":[{"name":"Corneoplastic Unit, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jtos.2024.11.005","article-title":"Biology and medicine on ocular surface restoration: Advancements and limits of limbal stem cell deficiency treatments","volume":"35","author":"Genna","year":"2025","journal-title":"Ocul. Surf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jtos.2024.01.003","article-title":"Comparative analysis of long-term results of three epithelial cell transplantation procedures for treating limbal stem cell deficiency","volume":"32","author":"Kengpunpanich","year":"2024","journal-title":"Ocul. Surf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/ICO.0000000000001820","article-title":"Global Consensus on Definition, Classification, Diagnosis, and Staging of Limbal Stem Cell Deficiency","volume":"38","author":"Deng","year":"2019","journal-title":"Cornea"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1097\/ICO.0000000000002358","article-title":"Global Consensus on the Management of Limbal Stem Cell Deficiency","volume":"39","author":"Deng","year":"2020","journal-title":"Cornea"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1002\/sctm.17-0003","article-title":"Navigating Market Authorization: The Path Holoclar Took to Become the First Stem Cell Product Approved in the European Union","volume":"7","author":"Pellegrini","year":"2018","journal-title":"Stem Cells Transl. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.4103\/ijo.IJO_117_19","article-title":"Simple limbal epithelial transplantation (SLET): Review of indications, surgical technique, mechanism, outcomes, limitations, and impact","volume":"67","author":"Shanbhag","year":"2019","journal-title":"Indian J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/ICO.0000000000002329","article-title":"Long-term Outcomes of Living-Related Conjunctival Limbal Allograft Compared with Keratolimbal Allograft in Patients with Limbal Stem Cell Deficiency","volume":"39","author":"Cheung","year":"2020","journal-title":"Cornea"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1136\/bjo.2003.038497","article-title":"Transplantation of cultivated autologous oral mucosal epithelial cells in patients with severe ocular surface disorders","volume":"88","author":"Nakamura","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.ophtha.2011.01.039","article-title":"Long-term outcome of cultivated oral mucosal epithelial sheet transplantation in treatment of total limbal stem cell deficiency","volume":"118","author":"Satake","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1136\/bjophthalmol-2020-318547","article-title":"Long-Term outcome of cultivated oral mucosal epithelial transplantation for fornix reconstruction in chronic cicatrising diseases","volume":"106","author":"Komai","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Toshida, H., Kasahara, T., Kiriyama, M., Iwasaki, Y., Sugita, J., Ichikawa, K., Ohta, T., and Miyahara, K. (2023). Early Clinical Outcomes of the First Commercialized Human Autologous Ex Vivo Cultivated Oral Mucosal Epithelial Cell Transplantation for Limbal Stem Cell Deficiency: Two Case Reports and Literature Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24108926"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jtos.2023.05.008","article-title":"Insights into the clinical development of regenerative medical products through a comparison of three cell-based products recently approved for limbal stem cell deficiency","volume":"29","author":"Aketa","year":"2023","journal-title":"Ocul. Surf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18088","DOI":"10.1038\/s41598-019-54571-7","article-title":"Simple oral mucosal epithelial transplantation in a rabbit model","volume":"9","author":"Inamochi","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e447","DOI":"10.1111\/aos.12397","article-title":"Cultivated oral mucosal epithelial transplantation for persistent epithelial defect in severe ocular surface diseases with acute inflammatory activity","volume":"92","author":"Sotozono","year":"2014","journal-title":"Acta Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1038\/eye.2011.230","article-title":"Adult human buccal epithelial stem cells: Identification, ex-vivo expansion, and transplantation for corneal surface reconstruction","volume":"25","author":"Priya","year":"2011","journal-title":"Eye"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.jtos.2020.06.005","article-title":"Long-term outcomes of cultivated cell sheet transplantation for treating total limbal stem cell deficiency","volume":"18","author":"Shimazaki","year":"2020","journal-title":"Ocul. Surf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s40123-024-01083-x","article-title":"Allogenic Cultured Limbal Epithelial Transplantation and Cultivated Oral Mucosal Epithelial Transplantation in Limbal Stem Cells Deficiency: A Comparative Study","volume":"14","author":"Elalfy","year":"2025","journal-title":"Ophthalmol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s00417-019-04316-z","article-title":"Comparison of the efficacy of different cell sources for transplantation in total limbal stem cell deficiency","volume":"257","author":"Wang","year":"2019","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.ophtha.2006.09.034","article-title":"Phenotypic Investigation of Human Eyes with Transplanted Autologous Cultivated Oral Mucosal Epithelial Sheets for Severe Ocular Surface Diseases","volume":"114","author":"Nakamura","year":"2007","journal-title":"Ophthalmology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhu, Y.F., Qiu, W.Y., Xu, Y.S., and Yao, Y.F. (2023). Clinical efficacy of a new surgical technique of oral mucosal epithelial transplantation for severe ocular surface disorders. BMC Ophthalmol., 23.","DOI":"10.1186\/s12886-023-02879-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ajo.2020.08.022","article-title":"Outcomes of Cultivated Oral Mucosal Epithelial Transplantation in Eyes with Chronic Stevens-Johnson Syndrome Sequelae","volume":"222","author":"Venugopal","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dobrowolski, D., Orzechowska-Wylegala, B., Wowra, B., Wroblewska-Czajka, E., Grolik, M., Szczubialka, K., Nowakowska, M., Puzzolo, D., Wylegala, E.A., and Micali, A. (2015). Cultivated Oral Mucosa Epithelium in Ocular Surface Reconstruction in Aniridia Patients. BioMed Res. Int., 2015.","DOI":"10.1155\/2015\/281870"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10561-016-9575-4","article-title":"Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease","volume":"17","author":"Prabhasawat","year":"2016","journal-title":"Cell Tissue Bank."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1167\/iovs.11-7847","article-title":"Transplantation of cultivated oral mucosal epithelium prepared in fibrin-coated culture dishes","volume":"53","author":"Hirayama","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1136\/bjo-2023-323617","article-title":"Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: A retrospective cohort study","volume":"108","author":"Aziza","year":"2023","journal-title":"Br. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/s13256-022-03502-8","article-title":"Transplantation of autologous cultivated oral mucosal epithelial sheets for limbal stem cell deficiency at Siriraj Hospital: A case series","volume":"16","author":"Booranapong","year":"2022","journal-title":"J. Med. Case Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1136\/bjo.2010.188714","article-title":"Long-term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders","volume":"95","author":"Nakamura","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ophtha.2012.07.053","article-title":"Visual improvement after cultivated oral mucosal epithelial transplantation","volume":"120","author":"Sotozono","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_29","unstructured":"Kim, Y.J., Lee, H.J., Ryu, J.S., Kim, Y.H., Jeon, S., Oh, J.Y., Choung, H.K., Khwarg, S.I., Wee, W.R., and Kim, M.K. (2025, December 02). Prospective Clinical Trial of Corneal Reconstruction with Biomaterial-Free Cultured Oral Mucosal Epithelial Cell Sheets [Internet]. Available online: https:\/\/journals.lww.com\/corneajrnl\/abstract\/2018\/01000\/prospective_clinical_trial_of_corneal.14.aspx."},{"key":"ref_30","unstructured":"Ang, L.P., Nakamura, T., Inatomi, T., Sotozono, C., Koizumi, N., Yokoi, N., and Kinoshita, S. (2025, December 02). Autologous Serum-Derived Cultivated Oral Epithelial Transplants for Severe Ocular Surface Disease [Internet]. Available online: www.archophthalmol.com."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1038\/eye.2009.60","article-title":"Transplantation of cultivated oral mucosal epithelial cells for severe corneal burn","volume":"23","author":"Ma","year":"2009","journal-title":"Eye"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1167\/iovs.11-7744","article-title":"Cultured Autologous Oral Mucosal Epithelial Cell Sheet (CAOMECS) Transplantation for the Treatment of Corneal Limbal Epithelial Stem Cell Deficiency","volume":"53","author":"Burillon","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_33","unstructured":"Gopakumar, V., Agarwal, S., Srinivasan, B., Krishnakumar, S., Maheswari Krishnan, U., and Iyer, G. (2025, December 02). Clinical Outcome of Autologous Cultivated Oral Mucosal Epithelial Transplantation in Ocular Surface Reconstruction [Internet]. Available online: https:\/\/journals.lww.com\/corneajrnl\/abstract\/2019\/10000\/clinical_outcome_of_autologous_cultivated_oral.12.aspx."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ajo.2005.09.003","article-title":"Midterm results on ocular surface reconstruction using cultivated autologous oral mucosal epithelial transplantation","volume":"141","author":"Inatomi","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1186\/s13287-020-01783-8","article-title":"Ex vivo cultivated oral mucosal epithelial cell transplantation for limbal stem cell deficiency: A review","volume":"11","author":"Cabral","year":"2020","journal-title":"Stem Cell Res. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1134\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:25:35Z","timestamp":1770024335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,1]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031134"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031134","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,1]]}}}