Purchase this article with an account.
Kamran M. Riaz, Ali R. Djalilian, Pejman Bakhtiari, Surendra Basti; Natural Course And Treatment Outcomes For Limbal Niche Dysfunction. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5120.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report the clinical presentation and outcome of medical management in patients with limbal niche dysfunction (LND)
Sixteen eyes of 11 consecutive patients with the diagnosis of LND were studied retrospectively. Diagnosis was made clinically by the presence of epithelial staining, superficial vascularization, and disarray or loss of the palisades of Vogt. The etiology of LND included contact lens wear (5 eyes), contact lens wear and rosacea (3 eyes), recurrent peripheral keratitis (4 eyes), benzalkonium chloride allergy (2 eyes), and idiopathic (2 eyes). All patients were treated medically with the goal of optimizing ocular surface health, and were given a combination regimen of preservative free lubricants, topical corticosteroids, and punctal plugs.
The extent of limbal involvement were clinically estimated and varied from 30 degrees to 330 degrees. Although all eyes demonstrated late staining epithelium most did not demonstrate a confluent opaque epithelium in the region of LND. The superior limbal quadrant was the most common site of involvement which was seen in all 16 eyes (100%), followed by temporal in 5 eyes (31%), nasal in 4 eyes ( 25%) and inferior in 2 eyes (12.5%). During the mean follow-up of 16 months (range: 2-60 months) all 16 eyes achieved signs of a stable ocular surface, as evidenced by the lack of recurrent erosion, persistent epithelial defect, late fluorscein staining, stromal haze and vascularity. The visual acuity in all 16 eyes improved. Initially, 5 eyes had corrected vision of 20/40 or better, and after medical management, 13 eyes (88.2%) achieved a best corrected visual acuity of 20/40 or better (p=0.001). All patients had at least one line improvement of vision with 10 eyes (62.5%) experiencing 2 or more lines of improvement after treatment.
While there is considerable literature regarding limbal stem cell deficiency, we report a milder disease involving limbal stem cells which may be described as limbal niche dysfunction. These cases appear to respond well to medical therapy including anti-inflammatory therapy as demonstrated in this small series.
This PDF is available to Subscribers Only