Iatrogenic limbal stem cell deficiency following drainage surgery for glaucoma

• Published in: Canadian journal of ophthalmology 2018-12, Vol.53 (6), p.574-579
• Main Authors: Muthusamy, Kirithika, Tuft, Stephen J.
• Format: Article
• Language: English
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2018.01.037

To describe conjunctival epithelial overgrowth of the cornea after surgery for glaucoma. This is a retrospective case series (setting: Moorfields Eye Hospital). Fourteen eyes of 13 patients with suspected limbal stem cell deficiency (LSCD) and corneal conjunctivalization after glaucoma drainage surgery. Conjunctivalization was defined as corneal epithelium that demonstrated late stain after topical application of fluorescein. Patient demographics, clinical features, potential risk factors, treatment, and final visual acuity were recorded. Main outcome measures were potential risk factors for conjunctivalization, complications, and response to treatment. Eleven eyes had multiple procedures involving the limbus, and in 11 eyes mitomycin C (MMC) or 5 fluorouracil had been used as an adjunct to reduce fibrosis. Affected eyes typically had a segment of late stain with fluorescein based at the site of previous glaucoma surgery, but in one eye there was total loss of the corneal epithelial phenotype. All eyes previously had topical treatment for their glaucoma but only 2 had an ocular surface disease associated with LSCD. Most cases were asymptomatic, but in 3 eyes there was visual loss when the abnormal phenotype crossed the visual axis. In these 3 eyes there was recurrent epithelial breakdown, often at the interface between the 2 epithelial phenotypes. In one individual, these symptoms resolved after limbal epithelial transfer from the unaffected contralateral eye. Glaucoma drainage surgery can damage the adjacent corneal limbal epithelial stem cell population. This can be associated with recurrent epithelial breakdown and reduced vision. If there is visual loss, limbal epithelial transplantation is a potential treatment option. Décrire la néoformation épithéliale conjonctivale de la cornée à la suite d’une chirurgie antiglaucomateuse. Il s’agit d’une série de cas rétrospective réalisée au Moorfields Eye Hospital et regroupant 14 yeux de 13 patients chez lesquels on soupçonnait la présence d’une insuffisance en cellules souches limbiques (ICSL) et qui avaient subi une conjonctivalisation cornéenne après une chirurgie de drainage du glaucome. La conjonctivalisation se définissait comme la présence d’un épithélium cornéen affichant un retard du marquage après l’application topique de fluorescéine. On a noté les données démographiques des patients, leurs caractéristiques cliniques, leurs facteurs de risque potentiels, leur traitement et leur acuité visuelle finale