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EW CORNEA 48 January 2016 by Vanessa Caceres EyeWorld Contributing Writer Limbal involvement was esti- mated to be 60 to 360 degrees, with the superior quadrant of the limbus the most common site of involve- ment. All patients had some degree of tear film dysfunction, reduced tear film break-up time, or both. The causes of LSCD includ- ed contact lens wear only (59%), contact lens wear in the setting of rosacea (14%), and surface toxicity from chronic benzalkonium chloride exposure from glaucoma medica- tions (9%). There were an additional 4 eyes (18%) with no other apparent causes aside from associated dry eye. Of the patient group, 4 eyes resolved with only conservative management, which included dis- continuation of contact lens wear, aggressive lubrication with preser- vative-free artificial tears, and lid hygiene or warm compresses when indicated. In the 11 patients (18 eyes) who had epithelial disease that persisted for longer than 3 months, additional medical treatments were used. Short- term pulse topical corticosteroids follow-up. The study was a retro- spective review. In the study, LSC was diagnosed by a loss of limbal architecture, the presence of superficial limbal neo- vascularization, and the advance- ment of an opaque epithelium. A whorl-like epitheliopathy or translucent epithelium was seen from the limbus; affected eyes also had late fluorescein staining of the involved epithelium with a wavy or whorl pattern. "Limbal stem cell disease was considered reversible or responsive to medical therapy if there was resolution of the above-mentioned features," the investigators wrote. The mean patient age was 39 years old. Patients had a variety of symptoms, including eye irritation, contact lens intolerance, and blurred or decreased vision. However, all patients had progressive epithe- liopathy with hazy, translucent epithelium that extended centrally from the limbus. Via staining, most patients had a whole-shaped and wavy pattern. Restoring ocular surface health is key to avoid further damage L imbal stem cell deficiency (LSCD) can lead to recurrent or non-healing epithelial defects, stromal scarring or melting, and possibly even pain or loss of vision. Research underway by Ali R. Djalilian, MD, associate professor of ophthalmology, cornea and ocular surface disease, Illinois Eye and Ear Infirmary, UIC Department of Ophthalmology & Visual Sciences, Chicago, has focused on how to prevent such severe effects. Finding the right treatment niche for LSCD T he limbal stem cells are required for the maintenance and regener- ation of the corneal epithelial cells. Limbal stem cell deficiency (LSCD) is an ocular condition that is more common than we think. There is a long list of etiologies for LSCD that include contact lens wear, rosacea, topical medication toxicity, and chemical burns. Severe LSCD can even lead to corneal blindness and poor prognosis for corneal transplantation. The patients with advanced disease may require limbal stem cell transplantation with systemic immunosuppression or implantation of a keratoprosthesis. However, LSCD in its milder forms may be reversible. Thus, it is crucial for the ophthalmologist to be able to recognize LSCD on clinical examination and to identify the condition early on. Optimizing the ocular surface environment has been reported to be successful in reversing the abnormal changes to the corneal epithelium that occur. This month's "Cornea editor's corner of the world" focuses on a condition called "Medically reversible limbal stem cell disease." Ali Djalilian, MD, discusses the results of his multicenter study on this subject, the role of inflammation in the worsening of these eyes, and management strategies for how ophthalmologists can help their patients who suffer from LSCD. Clara C. Chan, MD, FRCSC, FACS, cornea editor Cornea editor's corner of the world Longtime contact lens wearer with limbal stem cell deficiency Source: Ali R. Djalilian, MD Clinicians have become more aware of the limbal microenviron- ment—also called the niche—in LSC function and deficiency, Dr. Djalilian said. This microenviron- ment helps to maintain LSC func- tion. However, chemical injuries or autoimmune reactions can damage the LSCs and their niche. "We have to think of ways that we can improve the environment on the ocular surface and the micro- environment for limbal stem cells. Clinically, that means improving the tear film and controlling inflam- mation, the two factors that we can manipulate at this time," Dr. Djalilian said. Study details In their recent report "Medically reversible limbal stem cell disease," Dr. Djalilian and co-investigators focused on 22 eyes from 15 patients who had LCSD that was reversed with medical therapy. 1 The patients were seen at 3 tertiary referral cen- ters between 2007 and 2011. The patients had at least 3 months of