In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency

Background/aims: Limbal stem cell deficiency (LSCD) is characterised by a marked decrease in limbal stem cells. It is classified primarily using subjective slit-lamp observations. In vivo confocal microscopy (IVCM) can non-invasively provide objective information on the condition of the limbal niche...

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Autores: Caro Magdaleno, Manuel, Alfaro-Juarez, Asunción, Montero Iruzubieta, Jesús, Fernández Palacín, Ana, Muñoz Morales, Ana, Castilla Martino, Manuel Alberto, Spínola Muñoz, Consuelo, Rodríguez-de-la-Rúa, Enrique
Formato: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2019
País:España
Recursos:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/154425
Acesso em linha:https://hdl.handle.net/11441/154425
https://doi.org/10.1136/bjophthalmol-2017-311693
Access Level:acceso abierto
Palavra-chave:Limbal stem cell deficiency (LSCD)
In vivo confocal microscopy (IVCM)
Corneal sub-basal nerve plexus density (SND)
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spelling In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiencyCaro Magdaleno, ManuelAlfaro-Juarez, AsunciónMontero Iruzubieta, JesúsFernández Palacín, AnaMuñoz Morales, AnaCastilla Martino, Manuel AlbertoSpínola Muñoz, ConsueloRodríguez-de-la-Rúa, EnriqueLimbal stem cell deficiency (LSCD)In vivo confocal microscopy (IVCM)Corneal sub-basal nerve plexus density (SND)Background/aims: Limbal stem cell deficiency (LSCD) is characterised by a marked decrease in limbal stem cells. It is classified primarily using subjective slit-lamp observations. In vivo confocal microscopy (IVCM) can non-invasively provide objective information on the condition of the limbal niche, the corneal epithelial basal cell density and the corneal sub-basal nerve plexus density (SND). We here used IVCM to evaluate changes in SND to improve LSCD classification. Methods: We evaluated and classified 38 patients (76 eyes, 44 with LSC and 32 control eyes) using the Rama, López-García and Deng (clinical and confocal) classifications and evaluated the concordance of the confocal and clinical classifications. We constructed a logistic regression model using multivariate analysis to correlate different degrees of conjunctivalisation with IVCM parameters and used receiver operating characteristic (ROC) curve analysis to establish the SND cut-off value with maximum diagnostic sensitivity and specificity. Results: The classification systems correlated moderately at best (kappa, 0.449). The corneal SND of cases (6469±6295 µm/mm2) was less (p<0.001) than in controls (20911±4142 µm/mm2). The SND, but not basal cell density, played a protective role against conjunctivalisation (OR, 0.069; 95% CI 0.008–0.619; p=0.01). An SND cut-off value of 17 215 µm/mm2 yielded a sensitivity and specificity of 95.5% and 90.6%, respectively, for LSCD diagnosis. Conclusion: The density of the corneal sub-basal nerve plexus was inversely related to conjunctivalisation in LSCD. Further studies are needed to verify this and to elucidate the directionality between these factors.European Union (FEDER/FSE) \'Una manera de hacer Europa\'Iniciativa Andaluza en Terapias Avanzadas (IATA)Instituto de Salud Carlos III, as part of the Plan Nacional I+D+i 2013-2016 RD16/0008/0010RETICS OFTAREDPremio Anual Publicación Científica Destacada de la US. Facultad de MedicinaBMJ JournalsCirugíaMedicina Preventiva y Salud PúblicaCTS-312: Análisis de la Demanda Sanitaria2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/154425https://doi.org/10.1136/bjophthalmol-2017-311693reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésBritish Journal of Ophthalmology, 103 (3), 327-331.https://bjo.bmj.com/content/103/3/327info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1544252026-06-17T12:51:07Z
dc.title.none.fl_str_mv In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
title In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
spellingShingle In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
Caro Magdaleno, Manuel
Limbal stem cell deficiency (LSCD)
In vivo confocal microscopy (IVCM)
Corneal sub-basal nerve plexus density (SND)
title_short In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
title_full In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
title_fullStr In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
title_full_unstemmed In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
title_sort In vivo confocal microscopy indicates an inverse relationship between the sub-basal corneal plexus and the conjunctivalisation in patients with limbal stem cell deficiency
dc.creator.none.fl_str_mv Caro Magdaleno, Manuel
Alfaro-Juarez, Asunción
Montero Iruzubieta, Jesús
Fernández Palacín, Ana
Muñoz Morales, Ana
Castilla Martino, Manuel Alberto
Spínola Muñoz, Consuelo
Rodríguez-de-la-Rúa, Enrique
author Caro Magdaleno, Manuel
author_facet Caro Magdaleno, Manuel
Alfaro-Juarez, Asunción
Montero Iruzubieta, Jesús
Fernández Palacín, Ana
Muñoz Morales, Ana
Castilla Martino, Manuel Alberto
Spínola Muñoz, Consuelo
Rodríguez-de-la-Rúa, Enrique
author_role author
author2 Alfaro-Juarez, Asunción
Montero Iruzubieta, Jesús
Fernández Palacín, Ana
Muñoz Morales, Ana
Castilla Martino, Manuel Alberto
Spínola Muñoz, Consuelo
Rodríguez-de-la-Rúa, Enrique
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Cirugía
Medicina Preventiva y Salud Pública
CTS-312: Análisis de la Demanda Sanitaria
dc.subject.none.fl_str_mv Limbal stem cell deficiency (LSCD)
In vivo confocal microscopy (IVCM)
Corneal sub-basal nerve plexus density (SND)
topic Limbal stem cell deficiency (LSCD)
In vivo confocal microscopy (IVCM)
Corneal sub-basal nerve plexus density (SND)
description Background/aims: Limbal stem cell deficiency (LSCD) is characterised by a marked decrease in limbal stem cells. It is classified primarily using subjective slit-lamp observations. In vivo confocal microscopy (IVCM) can non-invasively provide objective information on the condition of the limbal niche, the corneal epithelial basal cell density and the corneal sub-basal nerve plexus density (SND). We here used IVCM to evaluate changes in SND to improve LSCD classification. Methods: We evaluated and classified 38 patients (76 eyes, 44 with LSC and 32 control eyes) using the Rama, López-García and Deng (clinical and confocal) classifications and evaluated the concordance of the confocal and clinical classifications. We constructed a logistic regression model using multivariate analysis to correlate different degrees of conjunctivalisation with IVCM parameters and used receiver operating characteristic (ROC) curve analysis to establish the SND cut-off value with maximum diagnostic sensitivity and specificity. Results: The classification systems correlated moderately at best (kappa, 0.449). The corneal SND of cases (6469±6295 µm/mm2) was less (p<0.001) than in controls (20911±4142 µm/mm2). The SND, but not basal cell density, played a protective role against conjunctivalisation (OR, 0.069; 95% CI 0.008–0.619; p=0.01). An SND cut-off value of 17 215 µm/mm2 yielded a sensitivity and specificity of 95.5% and 90.6%, respectively, for LSCD diagnosis. Conclusion: The density of the corneal sub-basal nerve plexus was inversely related to conjunctivalisation in LSCD. Further studies are needed to verify this and to elucidate the directionality between these factors.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/154425
https://doi.org/10.1136/bjophthalmol-2017-311693
url https://hdl.handle.net/11441/154425
https://doi.org/10.1136/bjophthalmol-2017-311693
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv British Journal of Ophthalmology, 103 (3), 327-331.
https://bjo.bmj.com/content/103/3/327
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BMJ Journals
publisher.none.fl_str_mv BMJ Journals
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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