Diagnostic criteria for limbal stem cell deficiency—a systematic literature review

Abstract

The diagnosis of limbal stem cell deficiency (LSCD) is often based on clinical manifestations with or without the use of tests to demonstrate the presence of goblet cells or of specific epithelial markers on the corneolimbal surface. This systematic review looks at the various diagnostic methods used in the diagnosis of LSCD in published interventional studies. The design is a systematic literature review. We did a systematic search on MEDLINE and PUBMED for articles published in English between January 1, 2003, and December 31, 2013. We collected data on diagnostic methods used to diagnose LSCD (clinical findings, impression cytology, immunohistochemistry for various epithelial markers, or in vivo confocal microscopy). Forty-six studies (mostly retrospective/interventional case series) met the inclusion criteria. All of the studies used clinical features as evidence of LSCD: discomfort, impaired vision, irregular epithelium, unstable tear film, persistent epithelial defects, scarring, fibrovascular pannus, neovascularization, keratinization, calcification, and opacification of the cornea. Eighteen studies (39.1%) used an additional test for the diagnosis; 17 studies (37.0%) used impression cytology for goblet cells, 4 studies (8.7%) used immunohistochemistry for epithelial markers, and 2 studies (4.3%) use in vivo confocal microscopy. The diagnosis of LSCD was made in most cases on clinical grounds alone. In some studies, diagnostic tests were used, but these varied considerably from study to study. Comparison of effectiveness of various interventions requires standardized diagnostic methods. Consensus on the diagnostic criteria for LSCD is essential and needs to be reached by the interested care providers.