Oral mucous membrane tarsal patch grafting: broadening indications and long-term outcomes.

Purpose: We present the surgical technique of localised excision of tarsal epithelium and replacement with oral mucous membrane tarsal patch grafting (MMTPG), to highlight novel indications of this technique for tarsal surface abnormalities beyond the lid margin.

Methods: Retrospective case series of patients who underwent MMTPG for refractory tarsal conjunctival disease in three centers, with outcome measures of corneal epitheliopathy, visual acuity (VA), and symptomatic improvement.

Results: 8 eyes of 8 patients were included, with surgical indications of medically recalcitrant Vernal Keratoconjunctivitis (VKC) (1), Giant Papillary Conjunctivitis (GPC) (1), or tarsal scarring in the setting of Ocular Cicatricial Pemphigoid (OCP) (2), Stevens-Johnson Syndrome (SJS) (2), advanced Meibomian Gland Dysfunction (MGD) (1) and Ligneous Conjunctivitis (LC) (1). Following MMTPG there were no recurrences of corneal epithelial defects or local tarsal conjunctival pathologies during the follow-up period (mean 28 months). Five eyes demonstrated an improvement in visual acuity of ≥2 Snellen chart lines. Symptomatic improvement was noted in all 8 eyes, and medication requirement was reduced.

Conclusion: This report provides a novel conceptual insight to the successful use of MMTPG, highlighting its use in a range of conditions in therapeutically resistant cases.