title: Existence of Normal Limbal Epithelium in Eyes With Clinical Signs of Total Limbal Stem Cell Deficiency.
abstract: OBJECTIVE
  To report the presence of normal limbal epithelium detected by in vivo confocal laser scanning microscopy (IVCM) in 3 cases of clinically diagnosed total limbal stem cell deficiency (LSCD).
  
  
  METHODS
  This is a retrospective case report consisting of 3 patients who were diagnosed with total LSCD based on clinical examination and/or impression cytology. Clinical data including ocular history, presentation, slit-lamp examination, IVCM, and impression cytology were reviewed.
  
  
  RESULTS
  The etiology was chemical burn in 3 cases. One patient had 2 failed penetrating keratoplasties. Another had allogeneic keratolimbal transplantation, but the graft failed 1 year after surgery. The third patient had failed amniotic membrane transplantation. These 3 patients presented with signs of total LSCD including the absence of normal Vogt palisades, complete superficial vascularization of the peripheral cornea, nonhealing epithelial defects, and corneal scarring. Impression cytology was performed in 2 cases to confirm the presence of goblet cells. However, each patient still had distinct areas of corneal and/or limbal epithelial cells detected by IVCM.
  
  
  CONCLUSIONS
  Residual normal limbal epithelial cells could be present in eyes with clinical features of total LSCD. IVCM seems to be a more accurate method to evaluate the degree of LSCD.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Chan
authors.affiliation: Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Qihua
authors.initials: Q
authors.lastname: Le
authors.affiliation: Cornea Division, Stein Eye Institute, University of California, Los Angeles, United States.
authors.forename: Andres
authors.initials: A
authors.lastname: Codriansky
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, United States.
authors.forename: Jiaxu
authors.initials: J
authors.lastname: Hong
authors.affiliation: Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Jianjian
authors.initials: J
authors.lastname: Xu
authors.affiliation: Cornea Division, Stein Eye Institute, University of California, Los Angeles, United States.
authors.forename: Sophie X
authors.initials: SX
authors.lastname: Deng
mesh_terms: D000368:Aged; D003315:Cornea / Q000166:cytology; D003316:Corneal Diseases / Q000175:diagnosis*; D004848:Epithelium; D019573:Epithelium, Corneal / Q000166:cytology*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*