Cell Morphology As An In Vivo Parameter For The Diagnosis Of Limbal Stem Cell Deficiency

To investigate basal epithelial cell morphology (CM) in the central cornea and limbal areas of eyes with limbal stem cell deficiency (LSCD).

Prospective, cross-sectional comparative study.

We developed a CM scoring system based on basal epithelial cell phenotypes graded from 0 (normal) to 3 (severe morphologic alterations); this system was evaluated by 2 independent masked observers. The CM score was compared with the LSCD clinical score, the mean best corrected visual acuity (BCVA), and in vivo laser scanning confocal microscopy (IVCM) parameters used to stage the LSCD (ie., basal epithelial cell density [BCD], basal epithelial thickness [ET], and sub-basal corneal nerve fiber length density [CNFL]).  

168 eyes with LSCD and 63 normal eyes were included. Compared with the control group, the LSCD group had significantly higher mean (± SD) CM scores in the central cornea (1.8 ± 0.7 vs 0.5 ± 0.4, respectively; P = 0.01) and limbal areas (1.6 ± 0.2 vs 1.3 ± 0.0, respectively; P < 0.05). The mean CM score in the central cornea was positively correlated with the clinical score (P < 0.01, r = 0.66) and negatively correlated with the BCVA (P < 0.01, r = 0.42). The CM scores were positively correlated with all IVCM parameters in the central cornea and limbal areas (all P < 0.001).

Basal epithelial CM is altered in the central cornea and limbus of eyes with LSCD and thus is an in vivo parameter that can be used to stage the clinical severity of the disease.