Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

Abstract

To describe the histopathological characteristics of limbal stem cell deficiency (LSCD) due to chronic vernal keratoconjunctivitis (VKC).Methods: This retrospective study included 14 eyes of 13 patients who underwent simple limbal epithelial transplantation for total LSCD from 2017 to 2018. The histological characteristics of the excised fibrovascular pannus were compared between 2 groups of 7 eyes, each with LSCD due to VKC and chemical burns (CB). Histological characteristics and type of inflammation were studied using special stains and immunohistochemistry. Fisher exact test was used to detect the statistical significance of the histological differences between both groups.Results: Epithelial hypertrophy, epithelial downgrowth, and eosinophilic infiltration were noted in all eyes in the VKC group (7/7, 100%). Epithelial hypertrophy was noted in 3 of the 7 (42.8%) eyes in the CB group, whereas epithelial downgrowth and eosinophilic infiltrates were absent. The average chronic inflammatory score of the pannus (5.28) was higher in VKC than in CB (3.85; P = 0.1080). The presence of goblet cells was higher in the CB group (5/7, 1.4%) than in the VKC group (3/4, 2.8%), although not statistically significant. Other histological differences between the groups were not statistically significant. Conclusions:The histopathological features of LSCD in VKC reveal some distinctive characteristics. These include the presence of epithelial downgrowth, eosinophilic infiltration, and epithelial solid and cystic implants. Although this information may be used to establish the diagnostic criteria for VKC as the cause of LSCD, further studies are needed to elucidate the reasons behind these unique findings.

Vernal Keratoconjunctivitis: A Systematic Review

“…IOP was medically controlled in 66%, and 34% required surgical treatment Medium Jongvanitpak et al [ 83 ] 2020 Thailand 20 7.9 To describe clinical manifestation of ocular allergy VKC was characterized by papillae and Trantas dots. Giant papillae and corneal ulcers were pathognomonic of VKC Medium Artesani et al [ 84 ] 2021 Italy 70 8.1 To evaluate health-related quality of life (HRQoL) in children at VKC diagnosis The QUICK questionnaire could be a useful tool to evaluate HRQoL in children with VKC High Donthineni et al [ 85 ] 2021 India 7 22.1 To describe the histopathological characteristics of limbal stem cell deficiency (LSCD) due to VKC The histopathological features of LSCD in VKC reveal some distinctive characteristics, like the presence of epithelial down growth, eosinophilic infiltration, and epithelial solid and cystic implants High Ghauri et al [ 86 ] 2021 UK 9 6.0 To understand the impact of VKC on daily life Families of children with VKC experience delays in receiving an accurate diagnosis and a lack of information and emotional support Medium Wadhwani et al [ 87 ] 2021 India 65 N/A To determine the knowledge and attitude about VKC in caregivers A total of 69.2% of caregivers were not aware of the symptoms of the disease, and 83% of caregivers were unaware of the side effects of eye drops used Medium Artesani et al [ 88 ] 2022 ...…”

Epithelial barrier dysfunction in ocular allergy

“… 29 Ocular surface inflammation in VKC and AKC often leads to severe suffering and complications such as corneal ulcers, tissue remodeling, scars, and rarely LSC deficiency, characterized by invasion of conjunctival epithelium into the cornea. 30 , 31 Further, treatment related complications such as increased intraocular pressure, glaucoma, and cataract arise due to side effects of steroids overuse warranting new and safer therapeutics. 28 , 32 , 33 Since the eyes are exposed directly to an outer environment, defective barrier must be primarily involved in the pathology of OA.…”

“…However, in the chronic forms, none of these completely control the signs and symptoms or prevent the recurrences 29 . Ocular surface inflammation in VKC and AKC often leads to severe suffering and complications such as corneal ulcers, tissue remodeling, scars, and rarely LSC deficiency, characterized by invasion of conjunctival epithelium into the cornea 30,31 . Further, treatment related complications such as increased intraocular pressure, glaucoma, and cataract arise due to side effects of steroids overuse warranting new and safer therapeutics 28,32,33 .…”