Limbal Basal Cell Density Decreases in Limbal Stem Cell Deficiency

Abstract

Purpose To investigate changes in limbal basal epithelial cell density in eyes with limbal stem cell deficiency (LSCD) using in vivo confocal laser scanning microscopy Design retrospective observational comparative study Methods A total of 43 eyes of 30 patients diagnosed with LSCD were included in the study. Ten eyes from normal subjects were included as control. Confocal imaging of the central cornea, and the superior, nasal, inferior and temporal limbus were collected using the Heidelberg Retina Tomograph III Rostock Corneal Module. Basal cell density in all locations was measured by two independent observers. Results The mean basal cell density of the normal group was 9264 ±598 cells/mm2 in the cornea and 7120 ±362 cells/mm2 in the limbus. In the LSCD group, the mean basal cell density in the cornea decreased 31.0% (6389 ±1820 cells/mm2, p<0.001) and in the limbus decreased 23.6% (5440 ±1123 cells/mm2, p<0.001) compared to that in the control. There was a trend of basal cell density decline in more advanced stage of LSCD. The basal cell density declined in the unaffected regions at a similar degree as that in the affected region in sectoral LSCD (p>0.05). The basal cell diameter increased by 24.6% in the cornea (14.7 μm) and by 15.7% in the limbus (15.5 μm) compared to the control. Conclusions Basal cell density in both central cornea and limbus decreases in LSCD. LSCs are affected globally and basal cell density could be used as a parameter to measure LSC function at the early stages of the disease process.

Correlation between the existence of the palisades of Vogt and limbal epithelial thickness in limbal stem cell deficiency

“…The clinical stages of LSCD could be divided into early, intermediate and late stages. Microstructural changes in the limbal area have a significant correlation with the clinical stage . Further investigation using high‐resolution imaging techniques is needed to evaluate the POV and limbal crypts in correlation to LSCD severity.…”

“…In vivo laser scanning confocal microscopy (LSCM), a non-invasive, real-time, three-dimensional technique that provides high-quality images of ocular surface tissues, has proved to be a promising tool in the diagnosis of LSCD. [4][5][6][7][8] LSCM is capable of not only defining the phenotype of the epithelium that covers the corneal surface but also visualizing the palisades of Vogt (POV), a widely accepted clinical marker to indicate the presence of LSCs. It has been confirmed that LSCM has a high degree of concordance with impression cytology in the diagnosis of LSCD.…”

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

“…13 Several reports have further demonstrated that the subbasal nerve plexus, corneal and limbal basal cell density and epithelial thickness correlate with the degree of LSCD. 16,17 These quantifiable parameters could be used to stage the degree of LSC function or deficiency.…”

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

“…4, 9–11, 13–16 The advantages of IVCM allow us to examine corneal nerve morphology and density in great detail. 10 The normal subbasal nerve plexus structure in healthy subjects has been studied.…”

“…Significant microstructure changes have been reported in patients with LSCD and include a decrease in basal epithelial cell density (BCD), epithelial thickness and subbasal nerve density (SND), and stage-dependent morphologic changes. 11, 16, 17 Although previous studies report a reduction in SND or even absence of subbasal nerve plexus in severe LSCD, 11, 18 the study populations were small and detail characterization of the nerve morphology was not performed. The purposes of the present study are to further characterize the morphological changes of subbasal nerve plexus, quantify the changes of subbasal nerve in different stages of LSCD and investigate whether the SND decrease is correlated with the severity of LSCD in a larger study population.…”