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Iatrogenic limbal stem cell deficiency

E J Holland1, G S Schwartz

  • 1Department of Ophthalmology, University of Minnesota School of Medicine, Minneapolis, USA.

Transactions of the American Ophthalmological Society
|January 1, 1997
PubMed
Summary
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This study identifies iatrogenic limbal stem cell deficiency in patients with ocular surface disease. Prior ocular surgery and topical medications were key factors contributing to this condition.

Area of Science:

  • Ophthalmology
  • Ocular Surface Disease
  • Stem Cell Biology

Background:

  • Limbal stem cell (SC) deficiency can lead to severe ocular surface disease.
  • Identifying novel causes of SC deficiency is crucial for effective treatment.
  • Previous etiologies for SC deficiency are well-documented, but undiagnosed cases exist.

Purpose of the Study:

  • To characterize patients with limbal stem cell (SC) deficiency without a previously recognized causative diagnosis.
  • To investigate the risk factors, clinical presentation, and outcomes of this specific patient group.

Main Methods:

  • Retrospective review of ocular surface disease patients (1987-1996).
  • Categorization of patients based on the etiology of limbal deficiency.
  • Analysis of patients lacking a specific, known cause for limbal deficiency, evaluating risk factors, clinical findings, and sequelae.

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Main Results:

  • Eight eyes across six patients presented with SC deficiency unrelated to known causes.
  • All affected eyes had undergone prior ocular surgery involving the corneoscleral limbus.
  • Concurrent external diseases and chronic topical medication use were common; five eyes had visual acuity of 20/200 or worse.

Conclusions:

  • The peripheral-to-central progression of epitheliopathy suggests stem cell deficiency.
  • Superior limbal surgical incisions were strongly linked to the deficiency, indicating surgical trauma as a primary factor.
  • The term 'iatrogenic limbal stem cell deficiency' is proposed, highlighting prior surgery and medications as etiological factors.