Purpose To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. Design Retrospective case series. Participants 22 eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with 3 or more months of follow-up. Methods Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, etiologies, location and duration of disease and medical inventions were analyzed. Main Outcome Measures Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity. Results Etiologies of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes) and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%). The corneal epithelial phenotype returned to normal with only conservative measures including lubrication and discontinuing contact lens wear in 4 patients (4 eyes) while in 11 patients (18 eyes) additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, and/or punctal occlusion. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4–60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P <0.0184). Conclusions Disturbances to the LSC function and/or niche may be potentially reversible by medical therapy. These cases, which represent a subset of patients with LSC deficiency, may be considered to have LSC niche dysfunction.

Postoperative infections are a serious issue that compromises device retention and visual outcomes after keratoprosthesis implantation.