Abstract
Purpose :
To evaluate the changes in the basal epithelial cell density (BCD) and its correlation with cell morphology in eyes with limbal stem cell deficiency (LSCD) using in vivo confocal laser scanning microscopy (IVCM).
Methods :
A total of 101 eyes of 74 patients (mean age 61.7±20.5 years) diagnosed with LSCD and 40 eyes of 34 age and gender healthy subjects (mean age 62.9±18.6 years) were included in this study. The number of eyes classified as mild, moderate and severe stage of LSCD were 42, 34 and 25, respectively. The central cornea, and the superior, inferior, temporal and nasal limbus were imaged using IVCM. Basal epithelial cell density in all locations was measured. The morphology of the cells was classified into 4 categories from 0-3 with 3 as the worst morphology of the cells. The relationship between BCD and the morphology of basal epithelial cells was evaluated.
Results :
The mean BCD in the central cornea in eyes with LSCD was 5652.8+-2063.0 cells/mm2 which is decreased by 36.7% as compared to control. The mean BCD in the superior, inferior, nasal and temporal limbus was 33.7%, 23.3%, 24.8% and 26.6%, respectively lower than that of normal eyes (all p<0.0001). The central BCD was reduced by 24.5%, 35.5%, 58.9% in the mild, moderate and severe stage of LSCD, respectively. The degree of BCD reduction in both cornea and limbus positively correlated with the severity of LSCD (all p<0.0001). In eyes with sectoral LSCD, a significant decrease of BCD was found in the clinically unaffected limbal areas. The mean reduction in the superior, inferior, nasal and temporal limbus was 20.%, 17.9%, 16.2% and 20.2%, respectively (all p<0.05 ). According to cell morphology half of the control eyes matched grade 0 and the rest grade 1, LSCD eyes were 3.9%, 55.4%, 18.8% and 21.7% classified as grade 0,1,2 and 3 respectively. According to the clinical severity, 88% of the mild and 50% of moderate LSCD patients matched with grade 1 and 68% of the severe correlated with grade 3. The grading of basal epithelial morphology had a significantly negative correlation with BCD at central cornea (r=-0.73916, p<0.0001).
Conclusions :
BCD was found to decrease at both central cornea and limbus in eyes with LSCD and the degree of BCD reduction had a positive correlation with the deterioration of cell morphology. BCD can be used as a parameter of LSC function.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.