In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET.

Emilio Pedrotti,Alessandra De Gregorio,Adriano Fasolo,Tommaso Merz,Neil Lagali,Tiziano Cozzini,Chiara Chierego,Giorgio Marchini,Jacopo Bonetto,Erika Bonacci

doi:10.3390/jcm9113574

Abstract

Examination of the corneal surface by in vivo confocal microscopy (IVCM) allows for objective identification of corneal and conjunctival cell phenotypes to evaluate different epithelialization patterns. Detection of a corneal-conjunctival epithelial transition could be considered as a sign of restored epithelial function following simple limbal epithelial transplantation (SLET). This is a prospective, interventional case series. We assessed patients with limbal stem cell deficiency (LSCD) by IVCM, preoperatively and at monthly intervals following SLET. Sectors in the central and peripheral cornea were scanned. Immediately upon detection of multi-layered cells with the epithelial phenotype in the central cornea and confirmation of epithelial transition in all corneal sectors, the decision for keratoplasty was taken. Ten patients were enrolled. After SLET, epithelial phenotype in the central cornea and an epithelial transition were identified within six and nine months in seven and one patients, respectively. One patient was a partial success and one failed. Five patients underwent keratoplasty, with stable results up to 12 months. Identification of the epithelial transition zone by IVCM permits assessment of the efficacy of SLET, enabling subsequent planning of keratoplasty for visual rehabilitation. The stability of the corneal surface following keratoplasty confirms that the renewal of the corneal epithelium was effectively retained.

Highlights

Limbal stem cell deficiency (LSCD) is a severe and debilitating condition affecting the ocular surface, caused by a decrease in the population and/or function of corneal epithelial stem cells located in the limbus
in vivo confocal microscopy (IVCM) examinations have been safely repeated starting from the first month postoperatively, when the amniotic membrane (AM) was almost completely integrated and the grafted limbal fragments were firmly adherent to the underlying stroma
IVCM was useful for both diagnosis of LSCD and in judging the efficacy of simple limbal epithelial transplantation’ (SLET)

Summary

Introduction

Limbal stem cell deficiency (LSCD) is a severe and debilitating condition affecting the ocular surface, caused by a decrease in the population and/or function of corneal epithelial stem cells located in the limbus. In patients with total LSCD, the conjunctival epithelium invades the cornea over the entire 360-degree circumference, followed by sub-epithelial fibrosis, neovascularization, development of a fibrovascular pannus and loss of vision in advanced stages. In such cases, treatments aim to recover limbal function and may consist of a cell therapy procedure based on the transplantation of allogeneic limbal stem cells harvested from a donor cornea or autologous limbal stem cells from the patient’s healthy fellow eye. A recent meta-analysis compared cultivated limbal transplant techniques and direct limbal transplantations (including SLET) and found more favorable outcomes for direct limbal transplantation [6]

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