Graefe's Archive for Clinical and Experimental Ophthalmology

, Volume 243, Issue 9, pp 870–876

Clinical and cytological findings in limbal stem cell deficiency

Authors

  • Marta Sacchetti
    • Interdisciplinary Center for Biomedical Research (CIR) Laboratory of OphthalmologyUniversity of Rome Campus Bio-Medico
  • Alessandro Lambiase
    • Interdisciplinary Center for Biomedical Research (CIR) Laboratory of OphthalmologyUniversity of Rome Campus Bio-Medico
  • Magdalena Cortes
    • Interdisciplinary Center for Biomedical Research (CIR) Laboratory of OphthalmologyUniversity of Rome Campus Bio-Medico
  • Roberto Sgrulletta
    • Interdisciplinary Center for Biomedical Research (CIR) Laboratory of OphthalmologyUniversity of Rome Campus Bio-Medico
  • Sergio Bonini
    • S. Raffaele Hospital
  • Daniela Merlo
    • Neuroscience DepartmentUniversity of Rome Tor Vergata
    • Interdisciplinary Center for Biomedical Research (CIR) Laboratory of OphthalmologyUniversity of Rome Campus Bio-Medico
    • G. B. Bietti Eye Foundation
Clinical Investigation

DOI: 10.1007/s00417-005-1159-0

Cite this article as:
Sacchetti, M., Lambiase, A., Cortes, M. et al. Graefe's Arch Clin Exp Ophthalmol (2005) 243: 870. doi:10.1007/s00417-005-1159-0

Abstract

Purpose

To evaluate and relate the clinical (including corneal sensitivity and tear function) and cytological (presence of goblet cells and cytokeratin 3- and 19-positive cells) features of limbal stem cell deficiency (LSCD).

Methods

Twenty-nine patients (44 eyes) with a clinical diagnosis of LSCD participated in this study. Corneal signs (epithelial alterations, superficial neovascularisation and stromal scarring) and cytological findings (presence of goblet cells and cytokeratins 3 and 19) were evaluated and scored (from 0 to 3) from each of the five corneal sectors. Corneal sensitivity (Cochet-Bonnet aesthesiometer) and tear function (Schirmer test and BUT) were also assessed. Cytological scores were correlated statistically with both corneal signs and sensitivity values.

Results

Cytokeratin 19-positive cells were found in 82% of corneal impression cytology samples, while goblet cells were identified in only 59% of these same samples. Cytokeratin 3-positive cells were present in 61% of LSCD eyes and in all unaffected eyes. Corneal sensitivity was significantly decreased in affected eyes compared with contralateral, healthy eyes (1.6±1.7 cm versus 5.7±0.3 cm). Tear function tests did not show significant changes. In LSCD eyes, goblet cells and cytokeratin 19-positive cells on the corneal surface were significantly correlated to corneal epithelial alterations and to corneal superficial neovascularisation (p<0.001). Corneal cytokeratin 3-positive cells were inversely related to epithelial alterations (p=0.003). Corneal sensitivity was decreased in corneal sectors with epithelial alterations (p<0.001), neovascularisation (p<0.001) and stromal abnormalities (p=0.049), and was indirectly related to the presence of goblet cells (p=0.005) and cytokeratin 19-positive cells (p<0.001).

Conclusion

This study confirmed the importance of cytological tests in the diagnosis of LSCD. Furthermore, the absence of goblet cells may not exclude corneal conjunctivalisation as demonstrated by cytokeratin 19 immunostaining. Lastly, corneal conjunctivalisation was associated with zone-specific impairment in corneal sensitivity.

Keywords

Limbal stem cell deficiencyCorneal sensitivityImpression cytologyCytokeratin 3Cytokeratin 19

Copyright information

© Springer-Verlag 2005