In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency

Caro-Magdaleno, Manuel; Alfaro-Juárez, A.; Montero-Iruzubieta, Jesús; Fernández-Palacín, Ana; Muñoz-Morales, A.; Castilla-Martino, M.; Spínola-Muñoz, Consuelo; Rodríguez-de-la-Rúa, Enrique

doi:10.1136/bjophthalmol-2017-311693

Cited by 14 publications

(11 citation statements)

References 15 publications

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“…An additional feature of conjunctival epithelium that has been described is the presence of goblet cells and intraepithelial cysts [21]. Unlike conjunctival epithelial cells, goblet cells have a limited role in the diagnosis of LSCD and a 20-50% detection rate in the cornea is reported [1,17,20]. In fact, in our series, only a few patients showed goblet cells supporting the diagnosis for LSCD.…”

Section: Discussionsupporting

confidence: 48%

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In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

Pedrotti

Chierego

Cozzini

et al. 2020

JCM

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Examination of the corneal surface by in vivo confocal microscopy (IVCM) allows for objective identification of corneal and conjunctival cell phenotypes to evaluate different epithelialization patterns. Detection of a corneal-conjunctival epithelial transition could be considered as a sign of restored epithelial function following simple limbal epithelial transplantation (SLET). This is a prospective, interventional case series. We assessed patients with limbal stem cell deficiency (LSCD) by IVCM, preoperatively and at monthly intervals following SLET. Sectors in the central and peripheral cornea were scanned. Immediately upon detection of multi-layered cells with the epithelial phenotype in the central cornea and confirmation of epithelial transition in all corneal sectors, the decision for keratoplasty was taken. Ten patients were enrolled. After SLET, epithelial phenotype in the central cornea and an epithelial transition were identified within six and nine months in seven and one patients, respectively. One patient was a partial success and one failed. Five patients underwent keratoplasty, with stable results up to 12 months. Identification of the epithelial transition zone by IVCM permits assessment of the efficacy of SLET, enabling subsequent planning of keratoplasty for visual rehabilitation. The stability of the corneal surface following keratoplasty confirms that the renewal of the corneal epithelium was effectively retained.

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Section: Discussionsupporting

confidence: 48%

“…Sub-basal nerve plexus and inflammatory cells (dendritic cells, DC) were also investigated, since a decline or complete absence of sub-basal nerves and presence of DC with different patterns has been reported [17,18].…”

Section: In Vivo Confocal Microscopymentioning

confidence: 99%

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

Pedrotti

Chierego

Cozzini

et al. 2020

JCM

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“…[36,37] for conjunctival cells, and MUC1 [38] and MUC5AC [39,40] for goblet cells. Markers of corneal epithelium are detected with low sensitivity, and therefore the absence of these markers cannot rule out LSCD [11,[41][42][43]. Additionally, goblet cells may be absent in cicatrising disease such as SJS/TEN.…”

Section: Diagnosis Of Lscd: Advances In High-resolution In Vivo Imagingmentioning

confidence: 99%

“…3). Low subbasal nerve plexus density has been shown to have 95.5% and 90.6% sensitivity and specificity for diagnosis of LSCD and is an early predictive sign for conjunctivalisation, preceding neovascularisation [43,46]. Goblet cells indicate the presence of conjunctival epithelium in the cornea (conjunctivalisation) and are a late sign of LSCD.…”

Section: In Vivo Laser Scanning Confocal Microscopymentioning

confidence: 99%

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to recreate the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.

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“…36,37 Since IVCM can image the entire cornea, it is also helpful in assessing corneal ectasias, dystrophies, degenerations, limbal stem cell deficiency, iridocorneal endothelial syndrome, sub-basal nerve architecture, diabetic neuropathy, corneal deposits, infective keratitis (especially Acanthamoeba and fungal keratitis) and post-surgical corneas. 29,[37][38][39]…”

Section: Confocal Microscopymentioning

confidence: 99%

Imaging the Corneal Endothelium in Fuchs Corneal Endothelial Dystrophy

Tone

Jurkūnas

2019

Seminars in Ophthalmology

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Fuchs endothelial corneal dystrophy (FECD) is characterized by the progressive degeneration of the corneal endothelium (CE). The purpose of this article is to review the diagnostic tools available to image and assess the CE in FECD. Slit-lamp biomicroscopy with specular reflection and retroillumination are important techniques to assess the CE. Objective diagnostic tests, such as retroillumination photographic analysis, specular microscopy, in vivo confocal microscopy (IVCM), and anterior segment optical coherence tomography, are valuable tools to evaluate the CE in FECD. Specular microscopy can be performed rapidly without touching the eye but requires a clear cornea with a smooth CE. In contrast, IVCM can image all layers of the cornea, even in advanced FECD. However, IVCM is contact-based and more technically challenging. It is important to select the appropriate objective diagnostic test to image and assess the CE in managing patients with FECD.

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In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency

Abstract: The density of the corneal sub-basal nerve plexus was inversely related to conjunctivalisation in LSCD. Further studies are needed to verify this and to elucidate the directionality between these factors.

Cited by 14 publications

References 15 publications

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

Imaging the Corneal Endothelium in Fuchs Corneal Endothelial Dystrophy

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