July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Prospective consecutive case series of patients with neurotrophic keratopathy (NK) associated with unilateral total limbal stem cell deficiency (LSCD) caused by severe ocular surface burns.
Author Affiliations & Notes
  • Gustavo S. Figueiredo
    Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
    Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
  • Oliver J. Baylis
    Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
    Sunderland Eye Infirmary, Sunderland, United Kingdom
  • Majlinda Lako
    Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
  • Francisco C Figueiredo
    Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
    Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
  • Footnotes
    Commercial Relationships   Gustavo Figueiredo, None; Oliver Baylis, None; Majlinda Lako, None; Francisco Figueiredo, None
  • Footnotes
    Support  Medical Research Council (MRC) UK: Reference number G0900879, Grant ID 91481
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2272. doi:
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      Gustavo S. Figueiredo, Oliver J. Baylis, Majlinda Lako, Francisco C Figueiredo; Prospective consecutive case series of patients with neurotrophic keratopathy (NK) associated with unilateral total limbal stem cell deficiency (LSCD) caused by severe ocular surface burns.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2272.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : LSCD is most commonly caused by ocular surface burns (chemical and thermal) and represents a complex therapeutic challenge. Neurotrophic keratopathy (NK) is a rare degenerative corneal disease caused by impairment of corneal innervation, leading to a decrease or absence of corneal sensation. We report here our assessment of corneal sensation in patients who underwent ex vivo expanded autologous limbal stem cell transplantation (ALSCT) following ocular surface burns.

Methods : Central corneal sensation was measured using Cochet-Bonnet's aesthesiometer in all patients (n=23) pre-operative (baseline) and at 6 months following ALSCT.

Results : All patients had successful restoration of the ocular surface (slit-lamp biomicroscopy, in vivo confocal microscopy and impression cytology) at 6 months. The mean age of patients was 44.7 years (range 24-81, SD 14.19). The mean BCVA (logMAR) at baseline was 1.67 (range 0.86 to 2.60, SD 0.57) in the LSCD eyes and -0.08 (range -0.3 to 0.14, SD 0.12) in the fellow eyes. There was a statistically significant difference in BCVA between the LSCD and fellow eyes at baseline (p<0.0001, Wilcoxon rank test). The mean Cochet-Bonnet aesthesiometry measurement in the LSCD eyes at baseline was 9.13 (range 0-30, SD 9.73) and at 6 months post-ALSCT was 12.0 (range 0-60, SD 19.76); whilst in the fellow eyes this was 59.13 (range 50-60, SD 2.88) at baseline and 59.5 (range 50-60, SD 2.24) at 6 months. The difference between the LSCD and fellow eyes was statistically significant at baseline and 6 months (both p<0.0001, Wilcoxon rank test). There was no statistically significant difference between measurements at 6 months post-ALSCT compared with baseline in either eye (p=0.26 in LSCD eyes and p=0.25 in fellow eyes, Wilcoxon rank test).

Conclusions : All corneas with total LSCD caused by ocular surface burns had severe impairment of corneal sensation that did not show any signs of improvement up to 6 months after ALSCT despite a successful outcome of their stem cell transplantation. However, topical neuropeptides and growth factors may represent a future adjunct therapeutic approach for the pre and post-ALSCT management of patients with severe NK due to LSCD caused by ocular surface burns that may enhance long-term clinical outcomes.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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