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E.K. Jacobson, J. Affeldt, C. Blanton, J. King; Total Limbal Stem Cell Deficiency Secondary to Anterior Segment Ischemic Syndrome . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4806.
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Purpose:To document for the first time development of total limbal stem cell deficiency in association with anterior segment ischemic syndrome. Methods: Observational case report. Results: A 66 year–old Hispanic male with a 23 year history of NIDDM underwent PRP and vitrectomy OD for PDR and VH, followed six months later by cataract extraction. Eleven months following the cataract surgery, he developed evidence of anterior segment ischemia manifested by ocular and periorbital pain without photophobia, episcleral injection, corneal edema with stromal neovascularization, rubeosis iridis, and variable intraocular pressure. At the same time, a dense 360 degree superficial pannus appeared associated with persistent epithelial defects. The pannus slowly progressed over the next 13 months to cover the entire corneal surface. Six months later, penetrating keratoplasty was performed which histologically revealed changes consistent with surface conjunctivalization. Conclusions: Anterior segment ischemic syndrome should be added to the differential for total limbal stem cell deficiency. In such cases, successful surgical intervention may require keratoprosthetics as opposed to keratoplasty and limbal stem cell transplantation.
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