Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Apr;130(4):440-5.
doi: 10.1001/archophthalmol.2011.378. Epub 2011 Dec 12.

Characterization of limbal stem cell deficiency by in vivo laser scanning confocal microscopy: a microstructural approach

Sophie X Deng  1 , Kunjal D Sejpal, Qiongyan Tang, Anthony J Aldave, Olivia L Lee, Fei Yu
Affiliations
Comparative Study

Characterization of limbal stem cell deficiency by in vivo laser scanning confocal microscopy: a microstructural approach

Sophie X Deng et al. Arch Ophthalmol. 2012 Apr.

Abstract

Objective: To evaluate the cellular changes in the corneal epithelium and surrounding structures in limbal stem cell deficiency (LSCD) by using in vivo laser scanning confocal microscopy.

Methods: This was a prospective comparative study that included 27 eyes of 20 patients with LSCD and 12 eyes of 10 healthy subjects. All subjects underwent slitlamp examination, and LSCD was classified into 3 groups on the basis of clinical presentation. Confocal imaging of the central cornea and 4 locations of limbus was performed. Morphologic characteristics of the corneal epithelium were studied. The basal epithelial cell density and subbasal nerve density in the central cornea were calculated, and a potential correlation between the decrease in basal epithelial cell density and subbasal nerve density in LSCD was investigated.

Results: The wing and basal epithelial cells became progressively metaplastic, and the basal epithelial cell density and subbasal nerve density in the early and intermittent stages decreased significantly compared with controls (all P < .01). Normal basal epithelial cell morphology was completely lost and subbasal nerves were absent in the late stage of LSCD. The decrease in basal cell density correlated with the decrease in subbasal nerve density in patients with LSCD (P = .03).

Conclusions: There are significant microstructural changes associated with early LSCD. These cellular changes could help to understand the disease process and classify and monitor limbal stem cell dysfunction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Slitlamp photographs of eyes at early (top panel), intermediate (middle panel), and late (bottom panel) stages of limbal stem cell deficiency. The fluorescein staining patterns are shown in the right column.
Figure 2
Figure 2
Representative confocal images of the wing and basal epithelial layers and subbasal nerve plexus at different clinical stages of limbal stem cell deficiency. A, Images of the wing (left column) and basal epithelial (middle column) layers in the central cornea. The subbasal nerve plexus is also shown (right column). The arrow indicates prominent nuclei. B, Images of the wing (left column) and basal epithelial (right column) layers in the limbus.
Figure 3
Figure 3
Box and whisker plot of central corneal basal epithelial cell density (A) and subbasal nerve density (B). There was a significant decrease in basal cell density and subbasal nerve density in all patients with limbal stem cell deficiency (LSCD) and in the subgroups of early-stage and intermediate-stage LSCD compared with controls. *P<.001. The dots indicate the mean.
Figure 4
Figure 4
Receiver operating characteristic curve for central corneal basal epithelial cell density (A) and subbasal nerve density (B). The lower cutoff basal epithelial cell density to diagnose limbal stem cell deficiency was 7930 cells/mm2 and resulted in a 95.5% sensitivity and 100% specificity. The lower cutoff subbasal nerve density was 53 nerves/mm2 and resulted in an 87.0% sensitivity and 91.7% specificity.
See this image and copyright information in PMC

References

    1. Schermer A, Galvin S, Sun TT. Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells. J Cell Biol. 1986;103(1):49–62. - PMC - PubMed
    1. Lavker RM, Tseng SC, Sun TT. Corneal epithelial stem cells at the limbus: looking at some old problems from a new angle. Exp Eye Res. 2004;78(3):433–446. - PubMed
    1. Tseng SC. Concept and application of limbal stem cells. Eye (Lond) 1989;3(pt 2):141–157. - PubMed
    1. Puangsricharern V, Tseng SC. Cytologic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology. 1995;102(10):1476–1485. - PubMed
    1. Dua HS, Azuara-Blanco A. Limbal stem cells of the corneal epithelium. Surv Ophthalmol. 2000;44(5):415–425. - PubMed

Publication types