Limbal Epithelial Cells Detected in Stage III Limbal Stem Cell Deficiency by Multimodal Anterior Segment Imaging

IF 4.7 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI:10.1016/j.ajo.2025.11.041

CLEMENCE BONNET , MEHRNOOSH MAALHAGHFARD , SOPHIE X. DENG

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引用次数: 0

Abstract

Purpose

Limbal stem cell deficiency (LSCD) is a potentially blinding corneal condition with heterogeneous clinical presentations. Anterior segment imaging, in particular anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) provide objective staging of LSCD. The goal of this study was to evaluate whether the fluorescein staining test is accurate in staging LSCD.

Design

Diagnostic and staging validity analysis.

Subjects

Subjects without eye diseases and those diagnosed with LSCD based on clinical exam, AS-OCT, and IVCM.

Methods

The severity of LSCD was staged clinically according to the global consensus guidelines using fluorescein staining. Multimodal imaging (AS-OCT and IVCM) was performed in the central cornea and four limbal quadrants (superior, inferior, nasal, and temporal). Imaging findings were correlated with clinical stage.

Main Outcomes Measures

Detection of morphologically limbal epithelial cells in eyes clinically graded as stage III LSCD, and AS-OCT characteristics corresponding to these identified clusters.

Results

A total of 220 eyes from 156 patients were analyzed. Based on fluorescein staining, 49 eyes (22.3%) were classified as stage I, 93 eyes (42.3%) as stage II, and 75 eyes (34.1%) as stage III LSCD. In all cases of stage III LSCD, AS-OCT confirmed severe central epithelial thinning, and IVCM demonstrated significantly reduced mean basal cell density in the central cornea. Despite this, clusters of limbal epithelial cells with normal morphology were detected by IVCM in 30 eyes (40.0%), appearing in one limbal quadrant in 26 eyes (86.7%) and in two quadrants in 4 eyes (13.3%). Correlation between IVCM and AS-OCT findings at the cluster locations was variable. Absence of hyporeflective epithelial layer was observed in 20 eyes (74.1%) and presence of hyporeflective layer was detected in 7 eyes (25.9%) by AS-OCT.

Conclusions

Despite being graded as total stage III LSCD by clinical exam using fluorescein staining, a significant proportion of eyes retained morphologically normal limbal epithelial cells. These findings highlight the importance of multimodal anterior segment imaging to achieve LSCD diagnostic accuracy, refine disease staging, and guide future personalized management strategies.

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多模态前段显像检测III期角膜缘干细胞缺乏症的角膜缘上皮细胞

目的：骨髓干细胞缺乏症（LSCD）是一种具有不同临床表现的潜在致盲性角膜疾病。前段成像，特别是前段光学相干断层扫描（AS-OCT）和体内共聚焦显微镜（IVCM）提供了LSCD的客观分期。本研究的目的是评估荧光素染色试验在LSCD分期中是否准确。设计诊断和分期效度分析。无眼病及经临床检查、AS-OCT、IVCM诊断为LSCD者。方法采用荧光素染色对LSCD的严重程度进行临床分期。在中央角膜和四个角膜缘象限（上、下、鼻和颞）进行多模式成像（AS-OCT和IVCM）。影像学表现与临床分期相关。主要结果：检测临床分级为III期LSCD的眼部角膜缘上皮细胞的形态学，以及与这些鉴定的细胞簇相对应的as - oct特征。结果156例患者共分析220只眼。根据荧光素染色，49眼（22.3%）为ⅰ期，93眼（42.3%）为ⅱ期，75眼（34.1%）为ⅲ期LSCD。在所有III期LSCD病例中，AS-OCT证实了严重的中央上皮变薄，IVCM显示中央角膜的平均基底细胞密度显著降低。尽管如此，IVCM在30只眼（40.0%）中检测到形态正常的角膜缘上皮细胞簇，26只眼（86.7%）出现在角膜缘的一个象限，4只眼（13.3%）出现在两个象限。IVCM和AS-OCT在集群位置的相关性是可变的。AS-OCT观察到低反射上皮层缺失20眼（74.1%），低反射上皮层存在7眼（25.9%）。结论尽管通过荧光素染色的临床检查将其分级为全III期LSCD，但仍有相当比例的眼睛保留了形态正常的角膜缘上皮细胞。这些发现强调了多模态前段成像在实现LSCD诊断准确性、细化疾病分期和指导未来个性化治疗策略方面的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.