Characterization of Limbal Stem Cell Deficiency by In Vivo Laser Scanning Confocal Microscopy

Abstract

To evaluate the cellular changes in the corneal epithelium and surrounding structures in limbal stem cell deficiency (LSCD) by using in vivo laser scanning confocal microscopy.Methods: This was a prospective comparative study that included 27 eyes of 20 patients with LSCD and 12 eyes of 10 healthy subjects. All subjects underwent slitlamp examination, and LSCD was classified into 3 groups on the basis of clinical presentation. Confocal imaging of the central cornea and 4 locations of limbus was performed. Morphologic characteristics of the corneal epithelium were studied. The basal epithelial cell density and subbasal nerve density in the central cornea were calculated, and a potential correlation between the decrease in basal epithelial cell density and subbasal nerve density in LSCD was investigated.Results: The wing and basal epithelial cells became progressively metaplastic, and the basal epithelial cell density and subbasal nerve density in the early and intermittent stages decreased significantly compared with controls (all PϽ .01). Normal basal epithelial cell morphology was completely lost and subbasal nerves were absent in the late stage of LSCD. The decrease in basal cell density correlated with the decrease in subbasal nerve density in patients with LSCD (P =.03).Conclusions: There are significant microstructural changes associated with early LSCD. These cellular changes could help to understand the disease process and classify and monitor limbal stem cell dysfunction.

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

“…In vivo confocal microscopy (IVCM) has been used to study the imaging characteristics of LSCD due to various etiologies, primarily to look at the details at a cellular level. [18][19][20] They reported changes such as epithelial hypertrophy, loss of BM, inflammatory infiltration, and presence of goblet cells, which was consistent with the findings in our study. However, these IVCM characteristics have not been specifically studied in LSCD secondary to VKC.…”

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

“…In vivo confocal microscopy (IVCM) has been used to study the imaging characteristics of LSCD due to various etiologies, primarily to look at the details at a cellular level. [18][19][20] They reported changes such as epithelial hypertrophy, loss of BM, inflammatory infiltration, and presence of goblet cells, which was consistent with the findings in our study. However, these IVCM characteristics have not been specifically studied in LSCD secondary to VKC.…”

A human-like model of aniridia-associated keratopathy for mechanistic and therapeutic studies

“…As AAK progressed, LSC function was compromised, resulting in limbal barrier breakdown and invasion of blood vessels into the central cornea. Additionally, our IVCM results showed the increasing severity of LSCD correlated with a loss of normal corneal epithelial cell morphology and a decline in central subbasal nerves, in line with human studies ( 15 , 30 ).…”

Characterization of the Corneal Subbasal Nerve Plexus in Limbal Stem Cell Deficiency

“…11 The current study confirms this observation in a larger LSCD population. We further investigated long nerve density, and nerve tortuosity in relation to the degree of LSCD and compared the number of total SND and long nerve density and morphologic changes in LSCD patients with those in normal subjects.…”

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

“…In vivo confocal microscopy (IVCM) has been used to study the imaging characteristics of LSCD due to various etiologies, primarily to look at the details at a cellular level. [18][19][20] They reported changes such as epithelial hypertrophy, loss of BM, inflammatory infiltration, and presence of goblet cells, which was consistent with the findings in our study. However, these IVCM characteristics have not been specifically studied in LSCD secondary to VKC.…”

A human-like model of aniridia-associated keratopathy for mechanistic and therapeutic studies

“…As AAK progressed, LSC function was compromised, resulting in limbal barrier breakdown and invasion of blood vessels into the central cornea. Additionally, our IVCM results showed the increasing severity of LSCD correlated with a loss of normal corneal epithelial cell morphology and a decline in central subbasal nerves, in line with human studies ( 15 , 30 ).…”

Characterization of the Corneal Subbasal Nerve Plexus in Limbal Stem Cell Deficiency

“…11 The current study confirms this observation in a larger LSCD population. We further investigated long nerve density, and nerve tortuosity in relation to the degree of LSCD and compared the number of total SND and long nerve density and morphologic changes in LSCD patients with those in normal subjects.…”

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

“…In vivo confocal microscopy (IVCM) has been used to study the imaging characteristics of LSCD due to various etiologies, primarily to look at the details at a cellular level. [18][19][20] They reported changes such as epithelial hypertrophy, loss of BM, inflammatory infiltration, and presence of goblet cells, which was consistent with the findings in our study. However, these IVCM characteristics have not been specifically studied in LSCD secondary to VKC.…”

A human-like model of aniridia-associated keratopathy for mechanistic and therapeutic studies

“…As AAK progressed, LSC function was compromised, resulting in limbal barrier breakdown and invasion of blood vessels into the central cornea. Additionally, our IVCM results showed the increasing severity of LSCD correlated with a loss of normal corneal epithelial cell morphology and a decline in central subbasal nerves, in line with human studies ( 15 , 30 ).…”

Characterization of the Corneal Subbasal Nerve Plexus in Limbal Stem Cell Deficiency

“…11 The current study confirms this observation in a larger LSCD population. We further investigated long nerve density, and nerve tortuosity in relation to the degree of LSCD and compared the number of total SND and long nerve density and morphologic changes in LSCD patients with those in normal subjects.…”