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Suanno G, Genna VG, Maurizi E, Dieh AA, Griffith M, Ferrari G. Cell therapy in the cornea: The emerging role of microenvironment. Prog Retin Eye Res 2024; 102:101275. [PMID: 38797320 DOI: 10.1016/j.preteyeres.2024.101275] [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: 10/11/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
The cornea is an ideal testing field for cell therapies. Its highly ordered structure, where specific cell populations are sequestered in different layers, together with its accessibility, has allowed the development of the first stem cell-based therapy approved by the European Medicine Agency. Today, different techniques have been proposed for autologous and allogeneic limbal and non-limbal cell transplantation. Cell replacement has also been attempted in cases of endothelial cell decompensation as it occurs in Fuchs dystrophy: injection of cultivated allogeneic endothelial cells is now in advanced phases of clinical development. Recently, stromal substitutes have been developed with excellent integration capability and transparency. Finally, cell-derived products, such as exosomes obtained from different sources, have been investigated for the treatment of severe corneal diseases with encouraging results. Optimization of the success rate of cell therapies obviously requires high-quality cultured cells/products, but the role of the surrounding microenvironment is equally important to allow engraftment of transplanted cells, to preserve their functions and, ultimately, lead to restoration of tissue integrity and transparency of the cornea.
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Affiliation(s)
- Giuseppe Suanno
- Vita-Salute San Raffaele University, Milan, Italy; Eye Repair Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Eleonora Maurizi
- Centre for Regenerative Medicine ''S. Ferrari'', University of Modena and Reggio Emilia, Modena, Italy
| | - Anas Abu Dieh
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - May Griffith
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.
| | - Giulio Ferrari
- Vita-Salute San Raffaele University, Milan, Italy; Eye Repair Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Hao S, Chen Z, Gu Y, Chen L, Sheng F, Xu Y, Wu D, Han Y, Lu B, Chen S, Zhao W, Yin H, Wang X, Riazuddin SA, Lou X, Fu Q, Yao K. Long-term PM2.5 exposure disrupts corneal epithelial homeostasis by impairing limbal stem/progenitor cells in humans and rat models. Part Fibre Toxicol 2023; 20:36. [PMID: 37759270 PMCID: PMC10523760 DOI: 10.1186/s12989-023-00540-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Limbal stem/progenitor cells (LSPCs) play a crucial role in maintaining corneal health by regulating epithelial homeostasis. Although PM2.5 is associated with the occurrence of several corneal diseases, its effects on LSPCs are not clearly understood. METHODS In this study, we explored the correlation between PM2.5 exposure and human limbal epithelial thickness measured by Fourier-domain Optical Coherence Tomography in the ophthalmologic clinic. Long- and short-term PM2.5 exposed-rat models were established to investigate the changes in LSPCs and the associated mechanisms. RESULTS We found that people living in regions with higher PM2.5 concentrations had thinner limbal epithelium, indicating the loss of LSPCs. In rat models, long-term PM2.5 exposure impairs LSPCs renewal and differentiation, manifesting as corneal epithelial defects and thinner epithelium in the cornea and limbus. However, LSPCs were activated in short-term PM2.5-exposed rat models. RNA sequencing implied that the circadian rhythm in LSPCs was perturbed during PM2.5 exposure. The mRNA level of circadian genes including Per1, Per2, Per3, and Rev-erbα was upregulated in both short- and long-term models, suggesting circadian rhythm was involved in the activation and dysregulation of LSPCs at different stages. PM2.5 also disturbed the limbal microenvironment as evidenced by changes in corneal subbasal nerve fiber density, vascular density and permeability, and immune cell infiltration, which further resulted in the circadian mismatches and dysfunction of LSPCs. CONCLUSION This study systematically demonstrates that PM2.5 impairs LSPCs and their microenvironment. Moreover, we show that circadian misalignment of LSPCs may be a new mechanism by which PM2.5 induces corneal diseases. Therapeutic options that target circadian rhythm may be viable options for improving LSPC functions and alleviating various PM2.5-associated corneal diseases.
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Affiliation(s)
- Shengjie Hao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Zhijian Chen
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang Province, China
| | - Yuzhou Gu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Lu Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Feiyin Sheng
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Yili Xu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Di Wu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Yu Han
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Bing Lu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Shuying Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Wei Zhao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Houfa Yin
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Xiaofeng Wang
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang Province, China
| | - S Amer Riazuddin
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Xiaoming Lou
- Department of Environmental and Occupational Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang Province, China.
| | - Qiuli Fu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China.
| | - Ke Yao
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China.
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Ocular Surface Squamous Neoplasia With Coexistent Microbial Keratitis: Incidence, Risk Factors, Clinical Features, Microbiological Profile, and Treatment Outcome. Cornea 2021; 41:294-303. [PMID: 34294636 DOI: 10.1097/ico.0000000000002809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the incidence, clinical features, microbiology, risk factors, and treatment outcomes in cases of ocular surface squamous neoplasia (OSSN) with coexisting microbial keratitis (MK). METHODS This was a retrospective case-control study from a cohort of 939 cases with OSSN. RESULTS Twenty eyes (2%) with OSSN and MK were included in the study group and 100 age-matched eyes with only OSSN as controls. Most common presentation was a combination of pain, redness, watering, and decreased vision (50%) over a median duration of 14 days. Mean corneal surface involvement by MK was 48% with corneal perforation in 6 cases (30%). Microbiology showed 10 culture positive cases for Gram-positive organisms (n = 5), fungus (n = 4), or mixed infection (n = 1). In the salvaged eyes, MK resolved in 9 eyes (90%) on medical treatment at a mean duration of 30 days and keratoplasty was performed in 1 eye. OSSN treatment included wide excisional biopsy (n = 9/18; 50%), extended enucleation (n = 7/18; 39%), and orbital exenteration in 1. Over a mean follow-up of 12 months, vision salvage was achieved in 7 of 18 (39%) and globe salvage in 10 of 18 (55%). Logistic regression analysis showed the following significant risk factors for MK in OSSN: male sex, human immunodeficiency virus seropositivity, increasing tumor diameter, limbal epicenter, temporal quadrant, noduloulcerative morphology, pigmentation, scleral invasion, keratin, and corneal component of the OSSN lesion. CONCLUSIONS Rarely, MK can coexist with OSSN leading to a poor treatment outcome. Male sex, human immunodeficiency virus seropositivity, large limbal pigmented OSSN lesion with keratin and corneal component, noduloulcerative morphology, and scleral invasion were risk factors for this association.
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Abstract
PURPOSE In recent decades, the medical and surgical treatment of limbal stem cell deficiency (LSCD) has evolved significantly through the incorporation of innovative pharmacological strategies, surgical techniques, bioengineering, and cell therapy. With such a wide variety of options, there is a need to establish a global consensus on the preferred approaches for the medical and surgical treatment of LSCD. METHODS An international LSCD Working Group was established by the Cornea Society in 2012 and divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to reach agreement on a strategic plan and methods after a comprehensive literature search. A writing group drafted the current study. RESULTS A consensus in the medical and surgical management of LSCD was reached by the Working Group. Optimization of the ocular surface by eyelid and conjunctival reconstruction, antiinflammatory therapy, dry eye and meibomian gland dysfunction treatment, minimization of ocular surface toxicity from medications, topical medications that promote epithelialization, and use of a scleral lens is considered essential before surgical treatment of LSCD. Depending on the laterality, cause, and stage of LSCD, surgical strategies including conjunctival epitheliectomy, amniotic membrane transplantation, transplantation of limbal stem cells using different techniques and sources (allogeneic vs. autologous vs. ex vivo-cultivated), transplantation of oral mucosal epithelium, and keratoprosthesis can be performed as treatment. A stepwise flowchart for use in treatment decision-making was established. CONCLUSIONS This global consensus provides an up-to-date and comprehensive framework for the management of LSCD.
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Bonnet C, Roberts JS, Deng SX. Limbal stem cell diseases. Exp Eye Res 2021; 205:108437. [PMID: 33571530 DOI: 10.1016/j.exer.2021.108437] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022]
Abstract
The function of limbal stem/progenitor cells (LSCs) is critical to maintain corneal epithelial homeostasis. Many external insults and intrinsic defects can be deleterious to LSCs and their niche microenvironment, resulting in limbal stem cell dysfunction or deficiency (LSCD). Ocular comorbidities, frequent in eyes with LSCD, can exacerbate the dysfunction of residual LSCs, and limit the survival of transplanted LSCs. Clinical presentation and disease evolution vary among different etiologies of LSCD. New ocular imaging modalities and molecular markers are now available to standardize the diagnosis criteria and stage the severity of the disease. Medical therapies may be sufficient to reverse the disease if residual LSCs are present. A stepwise approach should be followed to optimize the ocular surface, eliminate the causative factors and treat comorbid conditions, before considering surgical interventions. Furthermore, surgical options are selected depending on the severity and laterality of the disease. The standardized diagnostic criteria to stage the disease is necessary to objectively evaluate and compare the efficacy of the emerging customized therapies.
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Affiliation(s)
- Clémence Bonnet
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA; Cornea Department, Paris University, Cochin Hospital, AP-HP, F-75014, Paris, France.
| | - JoAnn S Roberts
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
| | - Sophie X Deng
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
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Borderie VM, Ghoubay D, Georgeon C, Borderie M, de Sousa C, Legendre A, Rouard H. Long-Term Results of Cultured Limbal Stem Cell Versus Limbal Tissue Transplantation in Stage III Limbal Deficiency. Stem Cells Transl Med 2019; 8:1230-1241. [PMID: 31486585 PMCID: PMC6877763 DOI: 10.1002/sctm.19-0021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 07/21/2019] [Indexed: 01/08/2023] Open
Abstract
We aimed to evaluate efficiency and safety of transplantation of limbal stem cells (LSC) cultured on human amniotic membrane with no feeders and to compare cultured LSC with limbal tissue transplantation. Thirty eyes with stage III LSC deficiency were treated with autologous (autoLSC) or allogeneic (alloLSC) cultured LSC transplantation (prospective phase II clinical trial; average follow-up time, 72 months) or autologous (autoLT) or allogeneic (alloLT) limbal tissue transplantation (retrospective control group; average follow-up time, 132 months) between 1993 and 2014. The 5-year graft survival defined by absence of recurrence of the clinical signs of limbal deficiency was 71% for autoLSC, 0% for alloLSC, 75% for autoLT, and 33% for alloLT. Visual acuity improved by 9.2 lines for autoLSC and 3.3 lines for autoLT. It decreased by 0.7 lines for alloLSC and 1.9 lines for alloLT. Adverse events were recorded in 1/7 autoLSC, 7/7 alloLSC, 6/8 autoLT, and 8/8 alloLT patients. Corneal epithelial defect was the only adverse event recorded after autoLSC, whereas severe sight-threatening adverse events were recorded in the remaining three groups. Compared with failed grafts, successful grafts featured greater decrease in fluorescein staining, greater superficial vascularization-free corneal area, lower variability of the corneal epithelial thickness, and higher corneal epithelial basal cell density. Autologous cultured LSC transplantation was associated with high long-term survival and dramatic improvement in vision and was very safe. Autologous limbal tissue transplantation resulted in similar efficiency but was less safe. Cadaver allogeneic grafts resulted in low long-term success rate and high prevalence of serious adverse events. Stem Cells Translational Medicine 2019;8:1230&1241.
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Affiliation(s)
- Vincent M Borderie
- Centre Hospitalier National d'Ophtalmologie des 15-20, Sorbonne Université, Paris, France
| | - Djida Ghoubay
- Centre Hospitalier National d'Ophtalmologie des 15-20, Sorbonne Université, Paris, France
| | - Cristina Georgeon
- Centre Hospitalier National d'Ophtalmologie des 15-20, Sorbonne Université, Paris, France
| | - Marie Borderie
- Centre Hospitalier National d'Ophtalmologie des 15-20, Sorbonne Université, Paris, France
| | - Céline de Sousa
- Banque de tissus, Etablissement Français du Sang-Ile-de-France, Paris, France
| | - Anne Legendre
- Banque de tissus, Etablissement Français du Sang-Ile-de-France, Paris, France
| | - Hélène Rouard
- Banque de tissus, Etablissement Français du Sang-Ile-de-France, Paris, France
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Abstract
PURPOSE To describe the rate, clinical/microbiological characteristics, and outcomes of infectious keratitis in eyes with limbal stem cell deficiency after ocular surface stem cell transplantation (OSST). METHODS In this retrospective chart review of 278 eyes that underwent OSST between January 2006 and December 2016, eyes treated for previous infectious keratitis (bacterial, fungal, or viral) were included. Demographics, risk factors, course, microbiological characteristics, and outcomes were assessed. RESULTS A total of 52 eyes (18.7%) of 48 patients (28 men and 20 women) developed 75 episodes (culture-proven or presumed) of infectious keratitis (range 1-4 episodes) with mean follow-up of 5.3 ± 3.6 years after OSST. The most common limbal stem cell deficiency etiologies included chemical/thermal (27 episodes), Stevens-Johnson syndrome (19 episodes), aniridia (8 episodes), and mucous membrane pemphigoid (8 episodes). There were 44 (58.7%) bacterial keratitis episodes, 24 (32%) fungal keratitis episodes, and 7 (9.3%) HSV keratitis episodes. Gram-positive bacteria (79%) and Candida species (73%) were the most common bacterial and fungal pathogens. Before infection, 33% had an epithelial defect, 69% had a bandage contact lens, 91% were on systemic immunosuppression, and 25% recently had undergone ocular surgery (<3 months). Although 75% resolved with antimicrobial treatment, 25% required a therapeutic keratoplasty (TPK; 2 cases needed multiple TPK). CONCLUSIONS Despite successful OSST surgery, infectious keratitis is relatively common, and aggressive medical/surgical therapy is warranted. Prophylactic topical antibiotics and a cicatrizing conjunctivitis diagnosis may account for the high proportion of fungal keratitis in this population.
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Borderie VM, Levy O, Georgeon C, Bouheraoua N. Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency. J Fr Ophtalmol 2018; 41:583-591. [PMID: 30166235 DOI: 10.1016/j.jfo.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe the outcomes of simultaneous penetrating keratoplasty (PK) and amniotic membrane transplantation (AMT) performed both as a ring-shaped graft and as a temporary patch in eyes with a history of limbal stem cell deficiency (LSCD). METHODS Prospective observational case series including 48 simultaneous PK/AMT procedures (48 patients) in eyes with a history of partial or total LSCD. Patients with total LSCD were first treated with limbal stem cell transplantation. The preoperative indication was graft failure in 58.3% of cases. Most recipients (89.6%) were at high-risk for rejection. RESULTS The mean graft reepithelialization time was 29.2±30.8 days. Graft reepithelialization was achieved in 30 days in 70.8% of cases. No AMT-related adverse events were observed. The mean time from keratoplasty-to-last visit was 84.5±54.5 months. The 3-year graft survival rate was 62.5%. Recurrence of corneal epithelial defects after graft reepithelialization (47.9%) was associated with lower graft survival (P=0.004). In eyes with successful grafts at the last visit, the mean LogMAR visual acuity was 1.90 (20/1575)±5 lines before keratoplasty and 0.89 (20/155)±10 lines at 5 years. A ring of amniotic membrane was visible between the graft stroma and the corneal epithelium on slit-lamp examination and optical coherence tomography in all successful cases. CONCLUSIONS In this series of eyes with a history of LSCD and at high-risk of rejection, simultaneous PK and AMT were associated with satisfactory graft survival and no additional adverse events.
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Affiliation(s)
- V M Borderie
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France.
| | - O Levy
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - C Georgeon
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
| | - N Bouheraoua
- CIC 1423, Pierre et Marie Curie University Paris 06, Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, 28, rue de Charenton, 75571 Paris, France
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Le Q, Xu J, Deng SX. The diagnosis of limbal stem cell deficiency. Ocul Surf 2018; 16:58-69. [PMID: 29113917 PMCID: PMC5844504 DOI: 10.1016/j.jtos.2017.11.002] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/24/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022]
Abstract
Limbal stem cells (LSCs) maintain the normal homeostasis and wound healing of corneal epithelium. Limbal stem cell deficiency (LSCD) is a pathologic condition that results from the dysfunction and/or an insufficient quantity of LSCs. The diagnosis of LSCD has been made mainly based on medical history and clinical signs, which often are not specific to LSCD. Methods to stage the severity of LSCD have been lacking. With the application of newly developed ocular imaging modalities and molecular methods as diagnostic tools, standardized quantitative criteria for the staging of LSCD can be established. Because of these recent advancements, effective patient-specific therapy for different stages of LSCD may be feasible.
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Affiliation(s)
- Qihua Le
- Stein Eye Institute, Cornea Division, David Geffen School of Medicine, University of California, Los Angeles, USA; Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Sophie X Deng
- Stein Eye Institute, Cornea Division, David Geffen School of Medicine, University of California, Los Angeles, USA.
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Infectious Keratitis in Limbal Stem Cell Deficiency: Stevens-Johnson Syndrome Versus Chemical Burn. Cornea 2016; 35:51-5. [PMID: 26555593 DOI: 10.1097/ico.0000000000000677] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the incidence, clinical and microbiological characteristics, risk factors, and therapeutic outcome of infectious keratitis in patients with limbal stem cell deficiency (LSCD) related to Stevens-Johnson syndrome (SJS) and corneal chemical burn. METHODS Medical records of 90 eyes of 59 patients who were diagnosed with LSCD resulting from SJS (52 eyes of 29 patients) or corneal chemical burn (38 eyes of 30 patients) were reviewed. RESULTS Infectious keratitis developed in 35% of LSCD patients with SJS (18 eyes, 14 patients) and in 18% of those with chemical burn (7 eyes, 7 patients). The development of infectious keratitis in SJS was significantly associated with the severity of chronic ocular surface complications in the cornea, conjunctiva, and eyelids and with the use of topical corticosteroids during the disease course. All cases of infectious keratitis following chemical burn occurred in patients with grade III or IV burn by Roper-Hall classification. Approximately 83% of culture-proven cases of infectious keratitis were bacterial infection, most of which (80%) were caused by Gram-positive bacteria. For resolution of infection, 17 eyes (68%) received surgery in addition to medical treatment, whereas 8 eyes (32%) received medical treatment alone. After infection resolution, the final visual acuity was decreased in 10 eyes (40%) compared with before infection. CONCLUSIONS Infectious keratitis is a common complication of LSCD associated with SJS or severe chemical burn to the cornea. Despite medical and surgical treatments, the visual outcome is poor.
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Zhou J, Jiang J, Wang S, Xia X. Epithelial cell adhesion molecule-1 (ECAM1) is required in the maintenance of corneal epithelial barrier integrity. Cell Biol Int 2015; 40:49-54. [PMID: 26269209 DOI: 10.1002/cbin.10522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/08/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Jinzi Zhou
- Department of Ophthalmology; Huaian First People's Hospital; Nanjing Medical University; Huaian 223300 China
| | - Jian Jiang
- Department of Ophthalmology; Xiangya Hospital Central South University; Changsha 410008 China
| | - Shuhong Wang
- Department of Ophthalmology; Huaian First People's Hospital; Nanjing Medical University; Huaian 223300 China
| | - Xiaobo Xia
- Department of Ophthalmology; Xiangya Hospital Central South University; Changsha 410008 China
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