Korean J Ophthalmol.  2019 Dec;33(6):500-505. 10.3341/kjo.2019.0095.

Contact Lens Induced Limbal Stem Cell Deficiency: Clinical Features in Korean Patients

Affiliations
  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. jeonhs@snu.ac.kr
  • 2Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

PURPOSE
To describe the clinical features of Korean patients with contact lens-induced limbal stem cell deficiency (CL-LSCD).
METHODS
Medical records of 22 patients who were diagnosed with CL-LSCD between 2014 and 2019 were reviewed retrospectively. Outcome measures included demographics, clinical presentation, treatment, clinical course, and pattern of contact lens (CL) wear.
RESULTS
Forty-two eyes of 22 patients were found to have typical changes associated with CL-LSCD. Twenty (91%) patients were women and mean age was 36 ± 12 years. All patients had myopia with mean spherical equivalent of −7.52 ± 3.2 diopter. Twenty (91%) patients had bilateral disease and the location of limbal involvement was diffuse in 20 eyes (47.6%) and partial in 22 eyes (52.4%, superior in 20 eyes and inferior in 2 eyes). Fourteen (63.6%) patients complained of decreased visual acuity. Average period of CL wear was 14 ± 9 years. Four patients used cosmetic colored CLs and four patients had a history of overnight CL wear. All 12 patients who completed follow-up (28 ± 42 weeks) showed improvement in visual acuity and ocular surface condition after cessation of CL wear and medical treatment. Of them, five (42%) patients showed full recovery while seven (58%) showed partial recovery.
CONCLUSIONS
If a patient with a history of CL wear for an extended period of time presents with decreased visual acuity, practitioners should perform detailed examinations with suspicion of CL-LSCD, including fluorescein staining. CL-LSCD is usually reversible and close follow-up with conservative treatment is recommended as the initial treatment option.

Keyword

Complications; Hydrophilic contact lenses; Limbal stem cell deficiency

MeSH Terms

Contact Lenses, Hydrophilic
Demography
Female
Fluorescein
Follow-Up Studies
Humans
Medical Records
Myopia
Outcome Assessment (Health Care)
Retrospective Studies
Stem Cells*
Visual Acuity
Fluorescein

Figure

  • Fig. 1 Typical clinical appearances of contact lens-induced limbal stem cell deficiency on slit lamp microscopy without and with fluorescein staining. Typical whorl-like epitheliopathy with loss of normal corneal clarity and late fluorescein staining in a whorl-like pattern with adjacent punctate staining were seen in all patients with various surface irregularities. (A,B) Patient 2, (C,D) patient 5, and (E,F) patient 3 had diffuse limbal stem cell deficiency; (G,H) patient 12 and (I,J) patient 13 had partial superior limbal involvement; (K,L) patient 11 had partial inferior limbal involvement.

  • Fig. 2 Clinical courses of representative cases with contact lens (CL)-induced limbal stem cell deficiency (A–C) at first presentation and (D–F) after medical treatment. (A) A 22-year-old woman (patient 9) with a 6-year history of CL wear showed typical whorl-like epitheliopathy involving the pupil area. (D) Five months after cessation of CL wear and medical treatment, the previous lesion had disappeared. (B) A 40-year-old woman (patient 4) with a 20-year history of CL wear showed diffuse CL-induced limbal stem cell deficiency. (E) Six weeks after treatment, the center surface irregularity had recovered although there was remaining superior limbal deficiency and subepithelial opacity. (C) A 47-year-old woman (patient 3) with a 20-year history of CL wear showed superior and inferior whorl-like epitheliopathy. (F) Three months after treatment, the center epitheliopathy had improved and only peripheral limbal deficiencies remained.

  • Fig. 3 A case of ulcerative keratitis in a patient with contact lens-induced limbal stem cell deficiency (patient 15). (A,B) Superior epithelial defect with infiltration adjacent to whorl-like irregular epithelium.


Reference

1. Thoft RA, Wiley LA, Sundarraj N. The multipotential cells of the limbus. Eye (Lond). 1989; 3(Pt 2):109–113.
2. Tseng SC. Concept and application of limbal stem cells. Eye (Lond). 1989; 3(Pt 2):141–157.
3. Dua HS, Azuara-Blanco A. Autologous limbal transplantation in patients with unilateral corneal stem cell deficiency. Br J Ophthalmol. 2000; 84:273–278.
4. Rossen J, Amram A, Milani B, et al. Contact lens-induced limbal stem cell deficiency. Ocul Surf. 2016; 14:419–434.
5. Martin R. Corneal conjunctivalisation in long-standing contact lens wearers. Clin Exp Optom. 2007; 90:26–30.
6. Chan CC, Holland EJ. Severe limbal stem cell deficiency from contact lens wear: patient clinical features. Am J Ophthalmol. 2013; 155:544–549.
7. Kim BY, Riaz KM, Bakhtiari P, et al. Medically reversible limbal stem cell disease: clinical features and management strategies. Ophthalmology. 2014; 121:2053–2058.
8. Bloomfield SE, Jakobiec FA, Theodore FH. Contact lens induced keratopathy: a severe complication extending the spectrum of keratoconjunctivitis in contact lens wearers. Ophthalmology. 1984; 91:290–294.
9. Jeng BH, Halfpenny CP, Meisler DM, Stock EL. Management of focal limbal stem cell deficiency associated with soft contact lens wear. Cornea. 2011; 30:18–23.
10. Kim JH, Song JS, Hyon JY, et al. A survey of contact lens-related complications in Korea: the Korean Contact Lens Study Society. J Korean Ophthalmol Soc. 2014; 55:20–31.
11. Tseng SC, Prabhasawat P, Barton K, et al. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol. 1998; 116:431–441.
12. Shen C, Chan CC, Holland EJ. Limbal stem cell transplantation for soft contact lens wear-related limbal stem cell deficiency. Am J Ophthalmol. 2015; 160:1142–1149.
13. Li W, Hayashida Y, Chen YT, Tseng SC. Niche regulation of corneal epithelial stem cells at the limbus. Cell Res. 2007; 17:26–36.
14. Pajoohesh-Ganji A, Pal-Ghosh S, Tadvalkar G, Stepp MA. Corneal goblet cells and their niche: implications for corneal stem cell deficiency. Stem Cells. 2012; 30:2032–2043.
15. Donisi PM, Rama P, Fasolo A, Ponzin D. Analysis of limbal stem cell deficiency by corneal impression cytology. Cornea. 2003; 22:533–538.
16. Choi HJ, Yum JH, Lee JH, et al. Clinical features and compliance in patients with cosmetic contact lens-related complications. J Korean Ophthalmol Soc. 2014; 55:1445–1451.
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr