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A. S. Hoehn, J. C. Affeldt, J. A. Irvine, E. K. Jacobson; Contact Lens Related Limbal Stem Cell Deficiency. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5119.
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Contact lens related limbal stem cell deficiency (CLR-LSCD) is a poorly described, under recognized and potentially serious complication of soft contact lens (SCL) wear. We identify the wear parameters, prodromal symptoms, presentation and clinical course of a group of these rarely reported patients.
Interventional case series.The diagnosis of LSCD was based on the clinical constellation of chronic ocular inflammation, persistent punctate keratopathy, and variable peripheral superficial corneal neovascularization.
Twelve eyes of 6 patients were identified with CLR-LSCD. The group was relatively young (mean age 35) with a female preponderance (2M, 4F). All wore SCL's and had done so for an extended period of time (mean 18 yrs). Presenting visual acuity was significantly reduced (mean= 20/60) as was quantitated corneal sensation (mean=20mm; Cochet-Bonnet aesthesiometer). Schirmers' with anesthesia was normal (mean=14.5mm). Universally described prodromal symptoms of redness, irritation, photophobia and blurred vision not relieved by any topical agent averaged 7 months. Slit lamp exam demonstrated diffusely 2- 3/4+ injected conjunctiva, and a distinctively course, strongly staining punctate keratopathy with a variable but predominantly superior distribution. Six eyes (50%) additionally demonstrated coalescence of the keratopathy into a wave-like or vortexing pattern. Recovery was slow and commonly incomplete, with 4 patients showing keratopathy persistence at 42, 102, 124, and 584 days post lens cessation respectively.
CLR-LSCD is a serious sight threatening complication of SCL wear clinically manifest by a distinctively patterned, course, frequently superior, wave-like or vortexing hypo esthetic epitheliopathy. It is chronically persistent requiring months for recovery, and may represent permanent injury. It generally provides several months of prodromal symptom warning, and all lens wear should be immediately discontinued at the first sign of its development.
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