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Medically Reversible Limbal Stem Cell Disease: Clinical Features and 1 Management Strategies

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posted on 12.05.2016, 00:00 authored by B.Y. Kim, K.M. Riaz, P. Bakhtiari, C.C. Chan, J.D. Welder, E.J. Holland, S. Basti, A.R. Djalilian
Purpose: To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. Design: Retrospective case series. Subjects: 22 eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with greater than 3 months follow-up. Methods: Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, etiologies, location and duration of disease and medical inventions were analyzed. Main Outcome Measures: Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity. Results: Etiologies of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes) and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%).The corneal epithelial phenotype returned to normal with only conservative measures includinglubrication and discontinuing contact lens wear in 4 patients (4 eyes) while in 11 patients (18 eyes) additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, and/or punctal occlusion. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P <0.0184).

Funding

The work by SB and ARD is supported in part by unrestricted grants from “Research to Prevent Blindness” to Departments of Ophthalmology at Northwestern University Feinberg School of Medicine and University of Illinois at Chicago, respectively. ARD is the recipient of a career development award from the National Eye Institute, NIH and from Research to Prevent Blindness.

History

Publisher Statement

This is the author’s version of a work that was accepted for publication in Ophthalmology: Journal of The American Academy of Ophthalmology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Ophthalmology: Journal of The American Academy of Ophthalmology,Volume 121, Issue 10, October 2014, Pages 2053–2058, DOI: 10.1016/j.ophtha.2014.04.025.

Publisher

Elsevier Inc.

issn

0161-6420

Issue date

01/10/2014

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