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Li JY, Cortina MS, Greiner MA, Kuo AN, Miller DD, Shtein RM, Veldman PB, Yin J, Kim SJ, Shen JF. Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:1121-1131. [PMID: 38678469 DOI: 10.1016/j.ophtha.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD). METHODS Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies. RESULTS After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections. CONCLUSIONS Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, California
| | - Maria S Cortina
- Department of Ophthalmology and Visual Science, University of Illinois College of Medicine, Chicago, Illinois
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Anthony N Kuo
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Peter B Veldman
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, Illinois
| | - Jia Yin
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joanne F Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
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Pérez I, Galindo S, López-Miguel A, Nieto-Miguel T, de la Mata A, López-Paniagua M, Alberca M, Herreras JM, Calonge M. In Vivo Confocal Microscopy in Limbal Stem Cell Deficiency After Mesenchymal Stem Cell Transplantation: A Sub-analysis from a Phase I-II Clinical Trial. Ophthalmol Ther 2023; 12:3251-3262. [PMID: 37773479 PMCID: PMC10640524 DOI: 10.1007/s40123-023-00809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the effect of mesenchymal stem cell transplantation (MSCT) and cultivated limbal epithelial transplantation (CLET) therapies on the limbus of patients suffering from limbal stem cell deficiency (LSCD). METHODS A sub-analysis of a phase I-II randomized, controlled, and double-masked clinical trial was performed to assess the changes in the anatomical structures of the limbus. In vivo confocal microscopy (IVCM) analysis was carried out in LSCD eyes before and 12 months after allogeneic MSCT or CLET. Epithelial phenotype of the central cornea, as well as the presence of transition zones and palisades of Vogt in the limbus, were assessed using Wilcoxon test. RESULTS Twenty-three LSCD (14 MSCT and nine CLET) eyes were included. The epithelial phenotype of the central cornea improved significantly (p < 0.001) from 15 (eight MSCT, seven CLET) and eight (six MSCT, two CLET) LSCD eyes showing conjunctival and mixed phenotypes, respectively, to eight (five MSCT, three CLET), five (two MSCT, three CLET), and ten (seven MSCT, three CLET) eyes showing conjunctival, mixed, and corneal phenotypes, respectively. Transition areas and palisades of Vogt were observed in at least one quadrant in nine (five MSCT, four CLET) and 16 (nine MSCT, seven CLET), and in four (two MSCT, two CLET) and six (three MSCT, three CLET) LSCD eyes before and after surgery, respectively. Changes in the transition zones and palisades were solely significant (p = 0.046) for the nasal and inferior quadrants, respectively. CONCLUSIONS MSCT and CLET improved the central corneal epithelial phenotype despite only minor changes in the anatomical structures of the limbus, as detected by IVCM technology. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01562002.
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Affiliation(s)
- Inmaculada Pérez
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
| | - Sara Galindo
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
| | - Alberto López-Miguel
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain.
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
| | - Teresa Nieto-Miguel
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
| | - Ana de la Mata
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Marina López-Paniagua
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Mercedes Alberca
- IBGM (Institute of Molecular Biology and Genetics) and University Scientific Park, Universidad de Valladolid, Valladolid, Spain
| | - José M Herreras
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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Density and distribution of dendritiform cells in the peripheral cornea of healthy subjects using in vivo confocal microscopy. Ocul Surf 2022; 26:157-165. [PMID: 35998820 DOI: 10.1016/j.jtos.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To establish dendritiform cell (DC) density and morphological parameters in the central and peripheral cornea in a large healthy cohort, using in vivo confocal microscopy (IVCM). METHODS A prospective, cross-sectional, observational study was conducted in 85 healthy volunteers (n = 85 eyes). IVCM images of corneal center and four peripheral zones were analyzed for DC density and morphology to compare means and assess correlations (p < 0.05 being statistically significant). RESULTS Central cornea had lower DC density (40.83 ± 5.14 cells/mm2; mean ± SEM) as compared to peripheral cornea (75.42 ± 2.67 cells/mm2, p < 0.0001). Inferior and superior zones demonstrated higher DC density (105.01 ± 7.12 and 90.62 ± 4.62 cells/mm2) compared to the nasal and temporal zones (59.93 ± 3.42 and 51.77 ± 2.98 cells/mm2, p < 0.0001). Similarly, lower DC size, field and number of dendrites were observed in the central as compared to the average peripheral cornea (p < 0.0001), with highest values in the inferior zone (p < 0.001 for all, except p < 0.05 for number of dendrites in superior zone). DC parameters did not correlate with age or gender. Inter-observer reliability was 0.987 for DC density and 0.771-0.922 for morphology. CONCLUSION In healthy individuals, the peripheral cornea demonstrates higher DC density and larger morphology compared to the center, with highest values in the inferior zone. We provide the largest normative cohort for sub-stratified DC density and morphology, which can be used in future clinical trials to compare differential changes in diseased states. Furthermore, as DC parameters in the peripheral zones are dissimilar, random sampling of peripheral cornea may be inaccurate.
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Liu X, Xu S, Wang Y, Jin X, Shi Y, Zhang H. Bilateral Limbal Stem Cell Alterations in Patients With Unilateral Herpes Simplex Keratitis and Herpes Zoster Ophthalmicus as Shown by In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 33974047 PMCID: PMC8114006 DOI: 10.1167/iovs.62.6.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose The purpose of this study was to investigate the limbal changes in the palisades of Vogt (POV) in patients with herpes simplex keratitis (HSK) and herpes zoster ophthalmicus (HZO) with the application of in vivo confocal microscopy (IVCM). Methods We enrolled 35 eyes of 35 consecutive patients with HSK and 4 patients with HZO in this observational study. Thirty-five participants were also recruited from a healthy population as the control group. All subjects were examined by IVCM in addition to routine slit-lamp biomicroscopy. The IVCM images of the corneal basal epithelial cells, corneal nerve, and the corneoscleral limbus were acquired and then were analyzed semiquantitatively. Results The rate of absent and atypical POV was significantly higher in the affected eyes of patients with HSK than in the contralateral eyes and eyes of controls (88.57% vs. 65.71% vs. 17.14%, P < 0.01). In the HZO group, the rate of absent and atypical POV was 100% in the affected eyes and 50% in the contralateral eyes. When compared to the contralateral unaffected eyes and control eyes, the average density of the central basal epithelial cells and the sub-basal nerve plexus density and the total number of nerves in the central area of the affected eyes were significantly lower in the HSK group (1541 ± 704.4 vs. 2510 ± 746.8 vs. 3650 ± 746.1 cells/mm2, P < 0.0001). Spearman's rank correlation showed that the presence of absent and atypical POV had a significant negative correlation with central corneal basal epithelial cells (rs = −0.44979, P < 0.0001), the density of total nerves (rs = −0.49742, P < 0.0001), and the total nerve numbers (rs = −0.48437, P < 0.0001). A significant positive correlation was established between the presence of absent and atypical POV and HSK severity in affected eyes in the superior, inferior, nasal, and temporal quadrants (rs = 0.68940, rs = 0.78715, rs = 0.65591, and rs = 0.75481, respectively, P < 0.0001) and the contralateral eyes (rs = 0.51636, rs = 0.36207, rs = 0.36990, rs = 0.51241, correspondingly, P < 0.0001). Conclusions Both eyes of patients with unilateral HSK and HZO demonstrated a profound and significant loss of limbal stem cells, which may explain the fact that HSK and HZO are risk factors for limbal stem cell deficiency (LSCD) in both eyes. The loss of LSCs was strongly correlated with the sub-basal nerve plexus and central basal epithelial cell alterations as shown by IVCM.
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Affiliation(s)
- Xintian Liu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Shuo Xu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Yingbin Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Yan Shi
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Street, Harbin City, Nangang District, Heilongjiang Province, China
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Bizheva K, Tan B, MacLellan B, Hosseinaee Z, Mason E, Hileeto D, Sorbara L. In-vivo imaging of the palisades of Vogt and the limbal crypts with sub-micrometer axial resolution optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2017; 8:4141-4151. [PMID: 28966853 PMCID: PMC5611929 DOI: 10.1364/boe.8.004141] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/11/2017] [Accepted: 08/13/2017] [Indexed: 05/05/2023]
Abstract
A research-grade OCT system was used to image in-vivo and without contact with the tissue, the cellular structure and microvasculature of the healthy human corneo-scleral limbus. The OCT system provided 0.95 µm axial and 4 µm (2 µm) lateral resolution in biological tissue depending on the magnification of the imaging objective. Cross-sectional OCT images acquired tangentially from the inferior limbus showed reflective, loop-like features that correspond to the fibrous folds of the palisades of Vogt (POV). The high OCT resolution allowed for visualization of individual cells inside the limbal crypts, capillaries extending from the inside of the POV's fibrous folds and connecting to a lateral grid of micro-vessels located in the connective tissue directly below the POV, as well as reflections from individual red blood cells inside the capillaries. Difference in the reflective properties of the POV was observed among subjects of various pigmentation levels of the POV. Morphological features observed in the high resolution OCT images correlated well with histology. The ability to visualize the limbal morphology and microvasculature in-vivo at cellular level can aid the diagnostics and treatment of limbal stem cell dysfunction and dystrophies.
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Affiliation(s)
- Kostadinka Bizheva
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
- School of Optometry and Vision Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
- Systems Design Engineering Department, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Bingyao Tan
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Benjamin MacLellan
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Zohreh Hosseinaee
- Systems Design Engineering Department, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Erik Mason
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Denise Hileeto
- School of Optometry and Vision Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Luigina Sorbara
- School of Optometry and Vision Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
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Le Q, Yang Y, Deng SX, Xu J. Correlation between the existence of the palisades of Vogt and limbal epithelial thickness in limbal stem cell deficiency. Clin Exp Ophthalmol 2016; 45:224-231. [PMID: 27591548 DOI: 10.1111/ceo.12832] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aims of the study were to investigate limbal epithelial thickness in subjects with limbal stem cell deficiency and to evaluate the correlation between the palisades of Vogt and limbal epithelial thickness. DESIGN Cross-sectional observational study. PARTICIPANTS Twenty-four subjects (39 eyes) with limbal stem cell deficiency and 20 normal controls (20 eyes). METHODS Anterior segment optical coherence tomography and laser scanning confocal microscopy were performed to assess each quadrant of the limbus. MAIN OUTCOME MEASURES Limbal epithelial thickness and palisades of Vogt morphology in each quadrant were characterized. The correlation between limbal epithelial thickness and palisades of Vogt was analysed. RESULTS The average limbal epithelial thicknesses in eyes with limbal stem cell deficiency were 19.9%, 23.4%, 13.8% and 13.5% less than normal controls at superior, inferior, nasal and temporal limbus (P = 0.008, 0.006, 0.014 and 0.011, respectively). Limbal epithelial thicknesses within limbal quadrants with palisades of Vogt were similar to those measured in the same quadrants in normal controls, whereas limbal epithelial thicknesses in the superior, inferior, nasal and temporal quadrants without palisades of Vogt were 27.8%, 29.8%, 14.7% and 15.6% less than the limbal epithelial thickness in corresponding regions of normal eyes (superior and inferior: P < 0.001; nasal and temporal: P = 0.005). Limbal epithelial thickness in the nasal and temporal quadrants was significantly less than that in the superior and inferior quadrants, both in normal controls and in limbal stem cell deficiency subjects(P < 0.001 and P = 0.019). Regression analysis showed that limbal epithelial thickness had a significant correlation with the presence of palisades of Vogt in each quadrant (superior, P = 0.002; inferior, P = 0.001; nasal, P = 0.047; temporal, P = 0.030). CONCLUSIONS A significant correlation was found between limbal epithelial thickness and the presence of palisades of Vogt. Limbal epithelial thinning as observed with anterior segment optical coherence tomography is a sign of limbal stem cell deficiency.
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Affiliation(s)
- Qihua Le
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Research Center, Eye and ENT Hospital of Fudan University, Shanghai, China.,Myopia Key Laboratory of Ministry of Health, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Yujing Yang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Sophie X Deng
- Stein Eye Institute, Cornea Division, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
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Lin HC, Tew TB, Hsieh YT, Lin SY, Chang HW, Hu FR, Chen WL. Using optical coherence tomography to assess the role of age and region in corneal epithelium and palisades of vogt. Medicine (Baltimore) 2016; 95:e4234. [PMID: 27583846 PMCID: PMC5008530 DOI: 10.1097/md.0000000000004234] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Using spectral-domain optical coherence tomography (OCT) to observe the morphology and epithelial thickness (ET) of the palisades of Vogt (POV), and to evaluate the role of age and region on these structures.One hundred twelve eyes of 112 healthy subjects were enrolled and divided into 4 groups: A (0-19), B (20-39), C (40-59), and D (≥60 years old). RTvue-100 OCT was applied on the cornea and the limbus. The morphology of the subepithelial stroma underneath the epithelium of POV was classified into typical and atypical types. Maximum ET of POV was measured manually from OCT images.The positive rate of typical POV in superior, nasal, temporal, and inferior limbus was: Group A: 100%, 69.2%, 65.4%, 100%; Group B: 100%, 73.5%, 61.8%, 94.1%; Group C: 95.8%, 41.7%, 37.5%, 83.3%; Group D: 67.9%, 0%, 3.6%, 25%, showing a significant decreasing tendency with age. The maximum ET of POV in superior, nasal, temporal, and inferior limbus was: Group A: 103.5 ± 10.1 um, 89.2 ± 9.7 um, 87.9 ± 13.6 um, 104.7 ± 14.1 um; Group B: 111.4 ± 15.8 um, 85.3 ± 9.9 um, 88.2 ± 8.6 um, 112.6 ± 19.7 um; Group C: 116.4 ± 16.4 um, 82.8 ± 11.6 um, 87.0 ± 11.6 um, 120.0 ± 25.6 um; Group D: 96.3 ± 17.9 um, 73.8 ± 15.9 um, 79.2 ± 16.7 um, 87.4 ± 18.5 um. Age-dependent change was observed. In general, the maximum ET of POV in superior/inferior quadrants was thicker than the other 2 quadrants.Spectral-domain OCT is a useful tool to observe the limbal microstructure and provide invaluable information. Aging and anatomic regions had significant effects on the microstructure of these areas.
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Affiliation(s)
- Hsuan-Chieh Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
- Department of Ophthalmology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu
| | - Teck Boon Tew
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
| | - Szu-Yuan Lin
- Department of Ophthalmology, Cathay General Hospital
| | - Huai-Wen Chang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
- Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan
- Correspondence: Wei-Li Chen, Department of Ophthalmology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Post Code 100, Taipei, Taiwan (e-mail: )
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KACHAM S, BIRRU B, PARCHA SR, BAADHE R. Limbal stem cell deficiency: special focus on tracking limbal stem cells. Turk J Biol 2016. [DOI: 10.3906/biy-1507-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ihnatko R, Eden U, Fagerholm P, Lagali N. Congenital Aniridia and the Ocular Surface. Ocul Surf 2015; 14:196-206. [PMID: 26738798 DOI: 10.1016/j.jtos.2015.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/26/2015] [Accepted: 10/15/2015] [Indexed: 12/15/2022]
Abstract
Aniridia is a congenital pan-ocular disorder caused by haplo-insufficiency of Pax6, a crucial gene for proper development of the eye. Aniridia affects a range of eye structures, including the cornea, iris, anterior chamber angle, lens, and fovea. The ocular surface, in particular, can be severely affected by a progressive pathology termed aniridia-associated keratopathy (AAK), markedly contributing to impaired vision. The purpose of this review is to provide an update of the current knowledge of the genetic, clinical, micro-morphological, and molecular aspects of AAK. We draw upon material presented in the literature and from our own observations in large aniridia cohorts. We summarize signs and symptoms of AAK, describe current options for management, and discuss the latest research findings that may lead to better diagnosis and new treatment or prevention strategies for this debilitating ocular surface condition.
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Affiliation(s)
- Robert Ihnatko
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ulla Eden
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Fagerholm
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Neil Lagali
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Chan EH, Chen L, Rao JY, Yu F, Deng SX. Limbal Basal Cell Density Decreases in Limbal Stem Cell Deficiency. Am J Ophthalmol 2015; 160:678-84.e4. [PMID: 26149968 DOI: 10.1016/j.ajo.2015.06.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/26/2015] [Accepted: 06/27/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate changes in limbal basal epithelial cell density in eyes with limbal stem cell deficiency (LSCD) using in vivo confocal laser scanning microscopy. DESIGN Retrospective observational comparative study. METHODS A total of 43 eyes of 30 patients diagnosed with LSCD were included in the study. Ten eyes from normal subjects were included as control. Confocal imaging of the central cornea, and the superior, nasal, inferior and temporal limbus were collected using the Heidelberg Retina Tomograph III Rostock Corneal Module. Basal cell density in all locations was measured by 2 independent observers. RESULTS The mean basal cell density of the normal group was 9264 ± 598 cells/mm(2) in the cornea and 7120 ± 362 cells/mm(2) in the limbus. In the LSCD group, the mean basal cell density in the cornea decreased 31.0% (6389 ± 1820 cells/mm(2), P < .001) and in the limbus decreased 23.6% (5440 ± 1123 cells/mm(2), P < .001) compared to that in the control. There was a trend of basal cell density decline in more advanced stages of LSCD. The basal cell density declined in the unaffected regions at a similar degree as that in the affected region in sectoral LSCD (P > .05). The basal cell diameter increased by 24.6% in the cornea (14.7 μm) and by 15.7% in the limbus (15.5 μm) compared to the control. CONCLUSIONS Basal cell density in both central cornea and limbus decreases in LSCD. Limbal stem cells (LSCs) are affected globally and basal cell density could be used as a parameter to measure LSC function at the early stages of the disease process.
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Xiang J, Le Q, Li Y, Xu J. In vivo confocal microscopy of early corneal epithelial recovery in patients with chemical injury. Eye (Lond) 2015; 29:1570-8. [PMID: 26381093 DOI: 10.1038/eye.2015.172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/11/2015] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate the early recovery of corneal epithelium in patients with chemical injuries by the application of in vivo laser scanning confocal microscopy (LSCM). METHODS LSCM was performed on 26 eyes of 18 consecutive patients at 1, 2, and 3 months post injury. The morphology of central corneal epithelium and limbus was evaluated. Analysis was performed to compare the densities of corneal apical surface cells (ASCs) and basal epithelial cells (BECs) among different injury severity and time points after injury. The comparisons were also made on inflammatory cells (ICs) and dendritic cells (DCs) infiltrating at the limbus. Moreover, the presence rate of palisades of Vogt (POV) was analyzed at 3 months post injury. RESULTS Corneal re-epithelialization was found within 3 months post injury in all eyes, except that persistent epithelium defect was identified in grade IV injured eyes even at 3 months after injury. The injury severity had a significantly negative correlation with the densities of ASCs. However, it had no relationship with the densities of BECs. The density of ICs at the limbus decreased significantly with the prolongation of follow-up, except in the grade I injured eyes. The presence rate of POV also had a significantly negative correlation with injury severity. CONCLUSION Epithelial recovery after chemical injury varied in cellular morphology and the densities of ASCs among eyes with different injury severity. The presence rates of POV decreased with the aggravation of injury. LSCM is a feasible method for observing the early recovery of corneal epithelium in patients with chemical injuries.
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Affiliation(s)
- J Xiang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Q Le
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Research Center, Eye & ENT Hospital of Fudan University, Shanghai, China.,Myopia Key Laboratory of Ministry of Health, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Y Li
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Myopia Key Laboratory of Ministry of Health, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - J Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Myopia Key Laboratory of Ministry of Health, Eye & ENT Hospital of Fudan University, Shanghai, China
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In Vivo Confocal Microscopy 1 Year after Autologous Cultured Limbal Stem Cell Grafts. Ophthalmology 2015; 122:1660-8. [DOI: 10.1016/j.ophtha.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
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Lathrop KL, Gupta D, Kagemann L, Schuman JS, Sundarraj N. Optical coherence tomography as a rapid, accurate, noncontact method of visualizing the palisades of Vogt. Invest Ophthalmol Vis Sci 2012; 53:1381-7. [PMID: 22266521 DOI: 10.1167/iovs.11-8524] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study explored the efficacy of optical coherence tomography (OCT) as a high-resolution, noncontact method for imaging the palisades of Vogt by correlating OCT and confocal microscopy images. METHODS Human limbal rims were acquired and imaged with OCT and confocal microscopy. The area of the epithelial basement membrane in each of these sets was digitally reconstructed, and the models were compared. RESULTS OCT identified the palisades within the limbus and exhibited excellent structural correlation with immunostained tissue imaged by confocal microscopy. CONCLUSIONS OCT successfully identified the limbal palisades of Vogt that constitute the corneal epithelial stem cell niche. These findings offer the exciting potential to characterize the architecture of the palisades in vivo, to harvest stem cells for transplantation more accurately, to track palisade structure for better diagnosis, follow-up and staging of treatment, and to assess and intervene in the progression of stem cell depletion by monitoring changes in the structure of the palisades.
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Affiliation(s)
- Kira L Lathrop
- University of Pittsburgh School of Medicine, Department of Ophthalmology, Eye and Ear Institute, Room 1026, 203 Lothrop Street, Pittsburgh, PA 15213, USA.
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