Existence of Normal Limbal Epithelium in Eyes With Clinical Signs of Total Limbal Stem Cell Deficiency

Abstract

Purpose To report the presence of normal limbal epithelium detected by in vivo confocal laser scanning microscopy (IVCM) in three cases of clinically diagnosed total limbal stem cell deficiency (LSCD). Methods This is a retrospective case report consists of three patients who were diagnosed with total LSCD based on clinical exam and/or impression cytology. Clinical data including ocular history, presentation, slit-lamp examination, IVCM and impression cytology were reviewed. Results The etiology was chemical burn in three cases. One patient has two failed penetrating keratoplasty. Another had allogeneic keratolimbal transplantation but the graft failed one year after surgery. The third patient had failed amniotic membrane transplantation. These three patients presented with signs of total LSCD including the absence of normal Vogt palisades, complete superficial vascularization of the peripheral cornea, non-healing epithelial defects, and corneal scarring. Impression cytology was performed in two cases to confirm the presence of goblet cells in two cases. Each patient however still had distinct areas of corneal and/or limbal epithelial cells detected by IVCM. Conclusions Residual normal limbal epithelial cells could be present in eyes with clinical features of total LSCD. IVCM appears to be a more accurate method to evaluate the degree of LSCD.

Global Consensus on Definition, Classification, Diagnosis, and Staging of Limbal Stem Cell Deficiency

“…IVCM, if available, could be used to detect residual limbal and corneal epithelial cells. 86,93 Due to the above sampling bias, impression cytology is not a quantitative test to stage LSCD.…”

“…In eyes with the clinical features of total LSCD as seen under slit-lamp biomicroscopy and confirmed by impression cytology, IVCM sometimes is able to detect well-demarcated, lacunae-like structures that are occasionally found in certain deep limbal stroma, which contain clusters of highly packed, normal limbal epithelial cells. 93 However, the correlation between AS-OCT and impression cytology has not been investigated because the resolution of AS-OCT is not at the cellular level.…”

On the new classification of eye burns

“…По результатам этого исследования был также сделан вывод, что тотальные сосудистые послеожоговые бельма наряду с конъюнктивальным эпителием частично могут быть покрыты и эпителием роговичного фенотипа (что согласуется с данными современной литературы [11,12]). В свете вышеизложенного очевидно, что, хотя при ожогах с повреждением 1 / 2 и более протяженности лимба далеко не всегда имеется тотальная гибель ЛЭСК, отнесение автором классификации таких ожогов к III степени тяжести имело все основания.…”

Classification of Limbal Stem Cell Deficiency Using Clinical and Confocal Grading

“…Other diseases could be mistaken as LSCD or the severity of LSCD could be misclassified based on clinical exam alone. 18,19 It is important to ascertain the diagnosis of LSCD and its extent before considering treatment options if possible. Accurate staging of LSCD is important in monitoring disease progression and treatment outcomes.…”