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Limbal stem cell deficiency in chronic and delayed-onset mustard gas keratopathy
Alireza Baradaran-Rafii1, Mohammad-Ali Javadi, Mozhgan Rezaei Kanavi
1Labbafinejad Medical Center, Shahid Beheshti University, Tehran, Iran.
Purpose:
To evaluate limbal stem cell deficiency (LSCD) using impression cytology in patients with chronic and delayed-onset mustard gas keratopathy (MGK).
Design:
Prospective observational case series.
Participants:
Thirty-five eyes of 18 patients (all male) with MGK were included.
Methods:
A consecutive series of patients with MGK underwent impression cytology. Finding of goblet cells on the corneal side of specimens was considered as LSCD. Severity of corneal clinical manifestation was graded as mild, moderate, and severe in each quadrant. Relation between impression cytology findings and clinical grading was evaluated.
Main Outcome Measures:
Impression cytology findings and clinical grading.
Results:
There was LSCD in at least 1 quadrant of cornea in all 35 eyes (100% of cases). No differences were found between impression cytology findings (positive vs. negative for corneal goblet cells) among different quadrants (P = 0.378). Clinical grading was the same between nasal and temporal quadrants (P = 0.266) and between superior and inferior quadrants (P = 0.263). By combining superior and inferior quadrants (vertical zone) and nasal and temporal quadrants (horizontal zone), corneal clinical grading was more severe in horizontal versus vertical zones (P<0.001). There was no relation between LSCD and corneal clinical severity (P = 0.893).
Conclusions:
A varying degree of LSCD was demonstrated in all patients with chronic or delayed-onset MGK using impression cytology. Corneal clinical manifestations are more severe in nasal and temporal quadrants. There was no relation between impression cytology findings (positive vs. negative for goblet cells) and corneal clinical grading. Other factors, such as perilimbal conjunctival ischemia, may play a role.
Insights
Limbal stem cell deficiency (LSCD) was found in all patients with chronic mustard gas keratopathy (MGK) using impression cytology. Corneal damage was more severe horizontally, but LSCD did not correlate with clinical severity.
Area of Science:
- Ophthalmology
- Cell Biology
- Toxicology
Background:
- Mustard gas (MG) exposure can cause delayed-onset ocular toxicity, including chronic keratopathy.
- Limbal stem cell deficiency (LSCD) is a potential complication of ocular chemical injury.
- Impression cytology is a minimally invasive technique for evaluating the ocular surface.
Observation:
- This study prospectively evaluated 35 eyes of 18 patients with chronic or delayed-onset mustard gas keratopathy (MGK).
- Impression cytology was used to assess limbal stem cell deficiency (LSCD) by identifying goblet cells on the corneal surface.
- Corneal clinical manifestations were graded for severity in each quadrant.
Findings:
- All patients (100%) exhibited LSCD in at least one corneal quadrant.
- Corneal clinical manifestations were significantly more severe in the horizontal (nasal and temporal) zones compared to the vertical (superior and inferior) zones.
- No significant correlation was found between the presence of LSCD and the clinical severity of corneal manifestations.
Implications:
- Impression cytology effectively demonstrates LSCD in chronic MGK.
- The horizontal-predominant corneal damage in MGK suggests specific mechanisms of injury or repair.
- Factors beyond LSCD, such as conjunctival ischemia, may contribute to the clinical presentation of MGK.
