A recent small-scale comparative study on eyes suffering from Limbal Stem Cell Deficiency (LSCD) has brought valuable insights to light. The study found a link between diminished corneal sensation, alterations in some subbasal nerve factors, and a heightened severity of the disease in LSCD eyes compared to healthy ones. The results hint at the possibility of neurotrophic keratopathy co-existing with LSCD, paving the way for its potential use as a diagnostic indicator.
The research was a forward-looking, cross-sectional, comparative study involving a total of 46 eyes (belonging to 35 patients) with LSCD and 14 eyes from 14 healthy control patients. The team of researchers gauged corneal sensation using a device known as a Cochet-Bonnet esthesiometer. They also employed in vivo confocal microscopy (IVCM) to capture images of the subbasal nerve plexus in both the central and limbal regions of the eyes. The data collected on corneal sensation and nerve parameters in the eyes, which were classified into three stages of LSCD based on an approved composite scoring system, were then compared with the control group.
The results indicated that the LSCD group had an average corneal sensation of 29.2 mm in the central corneal region and 33.6 mm in the limbal corneal regions. These figures stood in contrast to the control group who exhibited 57.6 mm and 54.3 mm, respectively. Furthermore, in cases where only a single sector of the central cornea or limbal region was impacted, the sensation in the affected area was significantly lower than in seemingly unaffected regions. An at least 80% reduction in subbasal nerve density, length, and branch density in LSCD eyes compared to controls was also noted. These reductions generally corresponded with a decrease in central corneal sensation and an increase in disease severity.
However, the study does have its limitations. The Cochet-Bonnet instrument used to measure corneal sensation is unable to evaluate the full spectrum of sensory fibers. Additionally, the quality of images produced by IVCM can be compromised in LSCD eyes due to the presence of subepithelial fibrosis.
From a clinical perspective, this study holds significant importance. When examining patients with LSCD, medical professionals should focus on nerve morphology and functionality. The results suggest that treatment for neurotrophic keratopathy could potentially aid in managing LSCD. However, more research is required to fully understand the relationship between neurotrophic keratopathy and LSCD.
Do note that Dr. Zeba Syed, one of the researchers, has disclosed financial ties with Bio-Tissue, Recordati Rare Diseases, Dompe, Glaukos, and Tarsus Pharmaceuticals.
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