Varma Shobhit, Shanbhag Swapna S, Donthineni Pragnya Rao, Mishra Dilip Kumar, Singh Vivek, Basu Sayan
The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, Telangana, India.
Ocular Pathology Services, L V Prasad Eye Institute, Hyderabad 500034, Telangana, India.
Diagnostics (Basel). 2021 Jun 21;11(6):1130. doi: 10.3390/diagnostics11061130.
This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A ( < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications.
本研究旨在确定经印片细胞学检查（IC）和活体共聚焦显微镜检查（IVCM）确诊的角膜缘干细胞缺乏（LSCD）患者眼前段高分辨率光学相干断层扫描（HR-OCT）及HR-OCT血管造影（HR-OCTA）的特征。这是一项单中心前瞻性横断面研究，纳入了22例临床怀疑患有LSCD的患者的24只眼，这些患者基于周边浅层角膜血管化和瘢痕形成被怀疑患有LSCD。由不知情的观察者进行并解读IC和IVCM检查，其中12只眼被诊断为患有LSCD，另12只眼未患LSCD。此外，还对5名无眼部病变的健康志愿者的10只眼进行了成像。对这34只眼的136张HR-OCT/A图像分析了12项成像参数；确定了最能提示LSCD的参数，并计算了其敏感性和特异性。在LSCD组中，最常见的病因是眼部化学烧伤（83%），而在非LSCD组中，最常见的病因是病毒性角膜炎（67%）。多因素逻辑回归分析显示，平均上皮反射率、平均基质反射率和平均浅层血管密度是HR-OCT/A上诊断LSCD的参数（<0.0001）。平均上皮反射率与基质反射率之比>1.29时，敏感性高（91.7%）、特异性高（98.75%）；平均浅层血管密度评分>0.38时，敏感性为97.9%，特异性为73.8%。总之，HR-OCT/A作为一种非侵入性成像方式，可能是确诊LSCD的有用工具，具有潜在的临床和研究应用价值。
