title: Medically reversible limbal stem cell disease: clinical features and management strategies.
abstract: OBJECTIVE
  To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Twenty-two eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with 3 months or more of follow-up.
  
  
  METHODS
  Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, causes, location and duration of disease, and medical inventions were analyzed.
  
  
  METHODS
  Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity.
  
  
  RESULTS
  Causes of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes), and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy, or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%). The corneal epithelial phenotype returned to normal with only conservative measures, including lubrication and discontinuing contact lens wear in 4 patients (4 eyes), whereas in 11 patients (18 eyes), additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, punctal occlusion, or a combination thereof. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P < 0.0184).
  
  
  CONCLUSIONS
  Disturbances to the LSC function, niche, or both may be reversible with medical therapy. These cases, which represent a subset of patients with LSC deficiency, may be considered to have LSC niche dysfunction.
authors.affiliation: University of Illinois Eye and Ear Infirmary, Chicago, Illinois.
authors.forename: Bryan Y
authors.initials: BY
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kamran M
authors.initials: KM
authors.lastname: Riaz
authors.affiliation: University of Illinois Eye and Ear Infirmary, Chicago, Illinois.
authors.forename: Pejman
authors.initials: P
authors.lastname: Bakhtiari
authors.affiliation: Cincinnati Eye Institute, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Clara C
authors.initials: CC
authors.lastname: Chan
authors.affiliation: University of Illinois Eye and Ear Infirmary, Chicago, Illinois.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Welder
authors.affiliation: Cincinnati Eye Institute, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: sbasti@northwestern.edu.
authors.forename: Surendra
authors.initials: S
authors.lastname: Basti
authors.affiliation: University of Illinois Eye and Ear Infirmary, Chicago, Illinois. Electronic address: adjalili@uic.edu.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Djalilian
mesh_terms: D000328:Adult; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003261:Contact Lenses / Q000009:adverse effects; D003316:Corneal Diseases / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*; D014792:Visual Acuity; D014801:Vitamin A / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D014801:Vitamin A