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Bryan Kim, Pejman Bakhtiari, Kamran Riaz, Clara Chan, Jeffrey Welder, Surendra Basti, Ali Djalilian; Medical management of limbal stem cell deficiency with anti-inflammatory therapy and tear film optimization. Invest. Ophthalmol. Vis. Sci. 2013;54(15):545.
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To characterize the clinical features and medical management of cases with limbal stem cell deficiency (LSCD) that were reversible with anti-inflammatory therapy.
Retrospective case series of 23 patients (35 eyes) at 3 tertiary referral centers who were seen between 2007 and 2011. These patients initially had clinical findings consistent with LSCD but then had resolution of these findings with only medical management. Main outcome measures included comparison of ocular surface findings during and after medical treatment and changes in visual acuity.
Mean patient age was 41 years (range, 18-77) with 9 males and 14 females. Etiologies of LSCD included contact lens wear (27 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride (BAK) toxicity (2 eyes), and idiopathic (3 eyes). Clinical findings included progressive epitheliopathy with associated opaque epithelium arising from the limbus, loss of limbal architecture, and late fluorescein staining in a wavy or whorl pattern. Extent of limbal disease involvement varied from 30 to 360 degrees of limbus, with the superior limbus as the most common site of involvement (31 eyes). Medical management was initiated in all patients who had persistent disease after 3 months of conservative measures (e.g. discontinuing contact lens wear). The treatments included: topical corticosteroids (11 eyes), topical cyclosporine (11 eyes), topical vitamin A (6 eyes), doxycycline (3 eyes), and punctal occlusion (15 eyes). Following treatment, all 35 eyes achieved a stable ocular surface and resolution of LSCD over a mean follow-up of 7.9 months (range, 2-36 months). 32 eyes experienced improvement in visual acuity from an initial mean log MAR of 0.363 (20/46) to a post-treatment mean log MAR of 0.136 (20/27) (P<0.001). 3 remaining eyes had unchanged visual acuity but had good starting vision (20/20 - 20/25).
LSCD can result from dysfunction of limbal stem cells or progenitor cells presumably due to disturbances to the limbal stem cell niche. Our results highlight the potentially reversible nature of this disease and support early intervention with medical therapy aimed at improving the tear film and suppressing inflammation.
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