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Dario A. Victoria, Sr., Beatriz E. Ramirez, Jose M. Herreras, Denise HiIeeto, M. Eugenia Mateo, Margarita Calonge; In Vivo Confocal Microscopy Criteria for Limbal Stem Cell Deficiency (LSCD) Syndrome. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5118.
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© ARVO (1962-2015); The Authors (2016-present)
To define in vivo confocal microscopy (CM) image criteria for LSCD syndrome based on the differences between slit lamp examination (SLE) and CM characteristics of affected and non-affected eyes.
Eleven patients with LSCD (6 unilateral and 5 bilateral) were examined using SLE and CM in central cornea and superior, inferior, nasal and temporal limbal areas. The following parameters were defined by SLE: presence of palisades of Vogt (PV) in the limbus and presence of conjunctivalization, corneal scarring, melting, calcification, and persistent epithelial defects in central cornea and limbus. Morphological parameters evaluated by CM were: i) characteristics of the different normal components of the PV: palisade ridges (PR), limbal crypts (LC), focal stromal projections, border of bright/dark cells, and ii) presence of the following abnormal findings: neovascularization (NV), epithelial metaplasia (EM), goblet cells, hyperreflective inflammatory cells, Langerhans cells, and epithelial cysts.
In 5 eyes with unilateral LSCD syndrome, CM evaluation of the healthy limbal areas demonstrated that PV were predominantly observed in the superior and inferior limbus (83.0%), which coincided with the observations obtained by SLE. In 11 eyes affected by total LSCD, PV were never detected by SLE; however CM detected PR and LC in 11.4% of cases in the superior, nasal, and inferior limbus, although the morphology of these residual palisade structures was atrophic compared to the normal ones. The most frequent pathological features detected by CM in central cornea and limbus were NV (92.7%), EM (98.2%) and presence of goblet cells (98.2%). These findings were consistent with conjunctivalization, which was the main characteristic detected in the same areas by SLE (94.5%).
Our results indicate that CM is a valuable and efficient technique to clinically characterize patients with LSCD. The absence of PV in SLE does not correlate with absence of palisade structures by CM. The following findings are suggested as CM diagnostic criteria of LSCD syndrome: 1) in the limbal area: atrophy or absence of PV, 2) in the central cornea and limbus: presence of epithelial metaplasia, neovascularization, and goblet cells.
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