How Limbal Stem Cell Deficiency Changes OSD Management

Multimodal strategy addresses tear film, epithelial homeostasis, stem cells, and underlying causes. Cheryl Guttman Krader reports from ASCRS 2021 in Las Vegas, USA.

How Limbal Stem Cell Deficiency Changes OSD Management
Cheryl Guttman Krader
Cheryl Guttman Krader
Published: Monday, November 1, 2021
Multimodal strategy addresses tear film, epithelial homeostasis, stem cells, and underlying causes. Cheryl Guttman Krader reports from ASCRS 2021 in Las Vegas, USA. Medical management for severe ocular surface disease associated with limbal stem cell deficiency (LSCD) requires a multipronged approach that incorporates reducing aggravating factors and optimising the microenvironment,” Charles S Bouchard MD, MA said. Speaking at ASCRS Cornea Day 2021, he outlined general management strategies. He also discussed published articles describing care regimens for eyes with various aetiologies of LSCD that illustrated how to customise treatment based on underlying cause and clinical features. Potential aggravating factors to address include the preservatives in topical medications such as benzalkonium chloride and contact lens wear (overwear). “The pathogenesis of LSCD associated with contact lens wear is multifactorial. Limbal epithelial stress can occur from mechanical trauma, hypoxia, dry eye, exposure to lens care solutions and their preservatives, and inflammation,” Dr Bouchard said. Strategies for optimising the ocular surface microenvironment include reducing aggravating factors, using preservative-free ocular lubricants, punctal occlusion, and/or autologous serum/plasma to improve the tear film. Other strategies include managing existing lid disease (ego, meibomian gland dysfunction, ocular rosacea) and controlling inflammation with agents such as topical corticosteroids, calcineurin inhibitors, lifitegrast, and/or amniotic membrane. Additional treatments that help restore homeostasis and promote the health of the ocular surface epithelium include recombinant human nerve growth factor (cenegermin, OXERVATE™), vitamin A ointment, and scleral contact lenses. Focusing on contact lens-induced LSCD, Dr Bouchard noted that it can take time to achieve an optimal outcome when initiating medical management after stopping contact lens wear. He illustrated his point by showing images depicting various levels of improvement achieved among three patients treated for periods ranging from six weeks to five months. He also mentioned a report describing how to treat corneal neovascularisation using the PROSE scleral lens to deliver bevacizumab. Citing other literature, Dr Bouchard highlighted medical (and surgical) management of eyes with LSCD associated with ocular rosacea, atopic and toxic keratoconjunctivitis, graft-versus-host disease, and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Finally, Dr Bouchard introduced the concept of the currently under-recognised role of the microbiome in the pathophysiology and immune regulation of ocular surface microenvironment. He presented a patient with a history of toxic epidermal necrolysis suffering chronic bilateral recurrent keratitis for many months. After conferring with Elmer Tu MD, University of Illinois, Chicago, Dr Bouchard prescribed topical linezolid 0.2%. “The keratitis cleared when the patient started on linezolid, and when the patient stopped the treatment because of the cost, the inflammation returned,” he said. This probable MRSA immune keratitis in patients with SJS/TEN was also previously reported by Chei Sotozono et al. Dr Charles S Bouchard is Professor and Chair, Department of Ophthalmology, Loyola University Medical Center, Chicago, Illinois, USA.
Tags: osd
Latest Articles
Towards a Unified IOL Classification

The new IOL functional classification needs a strong and unified effort from surgeons, societies, and industry.

Read more...

The 5 Ws of Post-Presbyopic IOL Enhancement

Fine-tuning refractive outcomes to meet patient expectations.

Read more...

AI Shows Promise for Meibography Grading

Study demonstrates accuracy in detecting abnormalities and subtle changes in meibomian glands.

Read more...

Are There Differences Between Male and Female Eyes?

TOGA Session panel underlined the need for more studies on gender differences.

Read more...

Simulating Laser Vision Correction Outcomes

Individualised planning models could reduce ectasia risk and improve outcomes.

Read more...

Mastering IOL Exchange

Tips and tricks for an uncomplicated replacement procedure.

Read more...

Need to Know: Aberrations, Aberrometry, and Aberropia

Understanding the nomenclature and techniques.

Read more...

Organising for Success

Professional and personal goals drive practice ownership and operational choices.

Read more...

Update on Astigmatism Analysis

Read more...

Is Frugal Innovation Possible in Ophthalmology?

Improving access through financially and environmentally sustainable innovation.

Read more...