EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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49 EW CORNEA January 2016 stand the critical factors that are involved in the limbal niche," Dr. Djalilian said. "This will help us were used, either non-preserved in the form of methylprednisolone 1% in 8 eyes (36%), preserved in the form of loteprednol etabon- ate (Lotemax and Alrex, Bausch + Lomb, Bridgewater, N.J.) in 8 eyes, or prednisolone acetate ophthalmic suspension 1% (Pred Forte, Allergan, Dublin) in 1 eye. One additional eye resolved with nightly vitamin A ointment. Clinicians also used corticoste- roids at various frequencies (from 2 hours to 3 times a day). "In all 17 eyes that were treated medically with steroids, a significant clinical response was noted with evidence of regressing conjunctival epithelial haze on review 1 month after the start of the steroid drops," the investigators wrote. Steroids were tapered off after 2 to 3 months in 14 eyes, and cyclosporine ophthalmic emulsion (Restasis, Allergan) was started twice daily. Three eyes required longer- term topical steroid treatment. One eye ultimately needed a PROSE scler- al lens (Boston Foundation for Sight, Needham, Mass.). The patients needed addition- al therapy that included punctal occlusion, inferior punctal plugs, treatment for rosacea, and vitamin A ointment used concurrently with steroids. After a mean follow-up of 15 months, the 22 eyes had a sta- ble ocular surface (range, 4 to 60 months). Visual acuity improved in 17 eyes; in the 5 other eyes, visual acuity improved subjectively and remained stable. The mean corrected visual acuity improved from 20/42 to 20/26. One eye had had corneal scarring and an initial visual acuity of 20/400 that improved to 20/200. Although this did not occur in the study, Dr. Djalilian said there are occasions where surgical options must be considered. "This consists of superficial keratectomy with amni- otic membrane in focal cases and limbal stem cell transplantation in more extensive cases," he said. Results The response that patients in the study had to steroids suggests that chronic subclinical inflammation plays an important role in the pathogenesis of LSCD, the investi- gators concluded. "We hypothesize that inflammation disturbs the normal milieu of the limbal niche and leads to dysfunction or aberrant differentiation of the LSCs, or both," they wrote. Clinicians treating LSCD also must take care to restore the ocular surface health and, specifically, the limbal niche. "We need to under- Be Part of WOC2016! • Choose from over 200 scientific sessions, 1,446 free papers and posters, and 26 subspecialty day sessions with 70 contributing societies • Learn about the latest products and services from over 100 exhibitors • Network with 900+ invited speakers and 7,000+ participants from 100+ countries World Ophthalmology Congress ® of the International Council of Ophthalmology Host: Mexican Society of Ophthalmology Co-host: Pan-American Association of Ophthalmology Register to Attend this Global Event February 5-9 in Guadalajara, Mexico woc2016.org Mark Your Calendar: WOC2018 June 16-19 Barcelona, Spain /attendwoc /attendwoc /icoandwoc /icoandwoc continued on page 50