Institutional members access full text with Ovid®

Share this article on:

Limbal Stem Cell Deficiency Following Phototherapeutic Keratectomy

Nghiem-Buffet, Minh-Huyên MD; Gatinel, Damien MD; Jacquot, Fabienne MD; Chaine, Gilles MD; Hoang-Xuan, Thanh MD

Case Reports

Purpose. To describe a case of limbal stem cell (LSC) deficiency following phototherapeutic keratectomy (PTK).

Methods. We analyzed the case of a 67-year-old man who developed LSC deficiency in his left eye following PTK for recurrent epithelial erosions. Predisposing factors included diabetes mellitus and rosacea.

Results. Surgical treatment consisted of debridement of the diseased corneal epithelium, followed by limbal autografting from the fellow eye. The cornea healed and remained transparent after 1 year. Histologic examination confirmed the diagnosis of LSC deficiency, showing the presence of goblet cells and inflammatory cells within the epithelium.

Conclusion. The extensive corneal mechanical debridement and laser photoablation incurred during phototherapeutic keratectomy can cause clinical LSC deficiency in patients with predisposing external diseases.

Corneal diseases associated with limbal stem cell (LSC) deficiency can be divided into two categories: those with LSC cell destruction and those involving dysfunction of the LSC stromal microenvironment. 1 The first category includes physical limbal injury (chemical and thermal injury, extensive limbal trauma, radiation therapy), 2 Stevens-Johnson syndrome, contact lens wear, 3 and severe microbial infection. The second category includes aniridia, 4 keratitis, corneal intraepithelial neoplasia, 5 neurotrophic keratopathy, peripheral ulcerative keratitis, idiopathic keratopathy, and pterygium.

Recently, Schwartz and Holland reported “iatrogenic LSC deficiency” in 14 eyes of 12 patients who had no associated corneal disease. 6 All the affected eyes had previously undergone surgery involving the corneoscleral limbus and had received long-term topical medication. The authors postulated that the surgical trauma had predisposed the eyes to LSC deficiency, which occurred when the limbus was exposed to a new insult, such as surgery, topical medication, or external disease (keratoconjunctivitis sicca or rosacea).

We describe a case of LSC deficiency occurring after phototherapeutic keratectomy (PTK) that matches the diagnostic criteria of iatrogenic LSC deficiency.

From the Fondation Ophtalmologique A. de Rothschild, 75940 Paris Cedex 19, France; and Service d'Ophtalmologie (M.H.N.B., G.C.), Hôpital Avicenne, 93009 Bobigny Cedex, France.

Submitted December 3, 2002.

Revision received March 27, 2003.

Accepted March 29, 2003.

Address correspondence and reprint requests to Damien Gatinel, Service du Professeur Thanh Hoang-Xuan, Fondation Ophtalmologique A. de Rothschild, 75940 Paris Cedex 19, France. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.