Fig. 1

External eye photographs of Patient 1. A 27-year-old man suffered from thermal burn OD caused by molten aluminum. After multiple AM transplantations and tarsoconjunctival grafting, there was still pannus ingrowth and severe symblepharon (A). After unsuccessful conjunctivo-limbal autografting, inflammation persisted with fibrovascular invasion and opacification of the lower cornea with symblepharon. His best corrected vision was 20/200 (B). One week after COMET, the corneal surface was intact without erosion or defects (C). Aggregates of the epithelial microspheres on AM can be seen with a high-magnification slit lamp (D). At post-OP 1.5 months, conjunctival inflammation was markedly reduced (E), and fluorescein staining revealed the OMEC sheet covering the lower cornea, limbus, and bulbar conjunctiva (F; margin indicated by arrows). One and half a years after COMET, no more symblepharon was seen, and his best corrected vision improved to 20/25 (G). At 34 months after transplantation, the cornea remained clear with a few peripheral NV (H), and the unique fluorescein staining confirmed the presence of OMECs (I; margin indicated by arrows)