Kate Anahita, Basu Sayan
The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, India.
The Cornea Institute, KAR Campus, LV Prasad Eye Institute, Hyderabad, India.
Front Med (Lausanne). 2022 May 25;9:836009. doi: 10.3389/fmed.2022.836009. eCollection 2022.
Limbal stem cell deficiency (LSCD) can cause significant corneal vascularization and scarring and often results in serious visual morbidity. An early and accurate diagnosis can help prevent the same with a timely and appropriate intervention. This review aims to provide an understanding of the different diagnostic tools and presents an algorithmic approach to the management based on a comprehensive clinical examination. Although the diagnosis of LSCD usually relies on the clinical findings, they can be subjective and non-specific. In such cases, using an investigative modality offers an objective method of confirming the diagnosis. Several diagnostic tools have been described in literature, each having its own advantages and limitations. Impression cytology and confocal microscopy (IVCM) aid in the diagnosis of LSCD by detecting the presence of goblet cells. With immunohistochemistry, impression cytology can help in confirming the corneal or conjunctival source of epithelium. Both IVCM and anterior segment optical coherence tomography can help supplement the diagnosis of LSCD by characterizing the corneal and limbal epithelial changes. Once the diagnosis is established, one of various surgical techniques can be adopted for the treatment of LSCD. These surgeries aim to provide a new source of corneal epithelial stem cells and help in restoring the stability of the ocular surface. The choice of procedure depends on several factors including the involvement of the ocular adnexa, presence of systemic co-morbidities, status of the fellow eye and the comfort level of the surgeon. In LSCD with wet ocular surfaces, autologous and allogeneic limbal stem cell transplantation is preferred in unilateral and bilateral cases, respectively. Another approach in bilateral LSCD with wet ocular surfaces is the use of an autologous stem cell source of a different epithelial lineage, like oral or nasal mucosa. In eyes with bilateral LSCD with significant adnexal issues, a keratoprosthesis is the only viable option. This review provides an overview on the diagnosis and treatment of LSCD, which will help the clinician choose the best option amongst all the therapeutic modalities currently available and gives a clinical perspective on customizing the treatment for each individual case.
角膜缘干细胞缺乏（LSCD）可导致明显的角膜血管化和瘢痕形成，并常常导致严重的视力损害。早期准确的诊断有助于通过及时适当的干预预防此类情况。本综述旨在增进对不同诊断工具的理解，并基于全面的临床检查提出一种算法化的管理方法。虽然LSCD的诊断通常依赖于临床发现，但这些发现可能具有主观性和非特异性。在这种情况下，使用一种检查方法可提供一种客观的确诊方法。文献中描述了几种诊断工具，每种都有其自身的优点和局限性。印迹细胞学和共焦显微镜检查（IVCM）通过检测杯状细胞的存在辅助LSCD的诊断。通过免疫组织化学，印迹细胞学有助于确认上皮细胞的角膜或结膜来源。IVCM和眼前节光学相干断层扫描均可通过描述角膜和角膜缘上皮变化辅助LSCD的诊断。一旦确诊，可采用多种手术技术之一治疗LSCD。这些手术旨在提供新的角膜上皮干细胞来源，并有助于恢复眼表的稳定性。手术方式的选择取决于多个因素，包括眼附属器的受累情况、全身合并症的存在、对侧眼的状况以及外科医生的熟练程度。在眼表湿润的LSCD患者中，自体和异体角膜缘干细胞移植分别适用于单眼和双眼病例。眼表湿润的双眼LSCD的另一种方法是使用不同上皮谱系的自体干细胞来源，如口腔或鼻腔黏膜。在双眼LSCD且伴有严重附属器问题的眼中，角膜移植是唯一可行的选择。本综述提供了LSCD诊断和治疗的概述，这将有助于临床医生在目前所有可用的治疗方式中选择最佳选项，并从临床角度为每个病例定制治疗方案。
