Diagnostic criteria for limbal stem cell deficiency before surgical intervention—A systematic literature review and analysis

Abstract

Keywords: limbal stem cell deficiency limbal stem cells diagnosis impression cytology in vivo laser scanning confocal microscopy imaging a b s t r a c t An accurate diagnosis of limbal stem cell deficiency (LSCD) is the premise of an appropriate treatment; however, there is no consensus about the diagnostic criteria for LSCD. We performed a systematic literature search of the peer-reviewed articles on PubMed, Medline, and Ovid to investigate how LSCD was diagnosed before surgical intervention. The methods used to diagnose LSCD included clinical presentation, impression cytology, and in vivo confocal microscopy. Among 131 eligible studies (4054 eyes), 26 studies (459 eyes, 11.3%) did not mention the diagnostic criteria. In the remaining 105 studies, the diagnosis of LSCD was made on the basis of clinical examination alone in 2398 eyes (62.9%), and additional diagnostic tests were used in 1047 (25.8%) eyes. Impression cytology was used in 981 eyes (24.2%), in vivo confocal microscopy was used in 29 eyes (0.7%), and both impression cytology and in vivo confocal microscopy were used in 37 eyes (0.9%). Our findings suggest that only a small portion of patients underwent a diagnostic test to confirm the diagnosis of LSCD. Treating physicians should be aware of the limitations of clinical examination in diagnosing LSCD and perform a diagnostic test whenever possible before surgical intervention. ª ScienceDirect journal h om epa ge: www.elsev ie r.com/locate/surv ophthal 0039-6257/$ e see front matter ª 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.survophthal.2019.06.008 s u r v e y o f o p h t h a l m o l o g y 6 5 ( 2 0 2 0 ) 3 2 e4 0 r e f e r e n c e s

Outcomes of Limbal Stem Cell Transplant

“…Only 26% of studies used diagnostic tests, such as impression cytology and/or in vivo confocal microscopy, to confirm the diagnosis of LSCD. 64 The limitation of using clinical signs in the diagnosis of LSCD needs to be recognized. 65,66 The International LSCD Working Group has established a consensus on the diagnosis, classification, and staging of LSCD, which will serve as a guideline for future clinical studies.…”

“…There was a lack of standardized criteria to stage the severity of LSCD and to define success, partial success, and failure; thus, comparison of the actual outcomes among different treatments was challenging. Only 26% of studies used diagnostic tests, such as impression cytology and/or in vivo confocal microscopy, to confirm the diagnosis of LSCD . The limitation of using clinical signs in the diagnosis of LSCD needs to be recognized .…”

Autologous simple limbal stem cell transplantation: a case series

“…Advanced stage of LSCD may show subepithelial fibrosis, conjunctivalization, stromal scarring, neovascularization, and recurrent epithelial defects. Diagnostic tools include impression cytology and/ or immunohistochemistry, in vivo confocal microscopy, and anterior segment optical coherence tomography 15. However, these are not considered as quantitative tools.…”