Optical Coherence Tomography Imaging of the Palisades of Vogt to Assist Clinical Evaluation and Surgical Planning in a Case of Limbal Stem-Cell Deficiency

Abstract

Purpose To describe the use of volumetric optical coherence tomography (OCT) imaging to assist evaluation of a patient referred for autologous limbal stem cell transplant. Methods This is a case report of a fifty year-old patient presenting with unilateral limbal stem cell deficiency who was referred for autologous limbal stem cell transplant. The presence of Salzmann's nodules in the donor eye raised questions about the efficacy of transplantation, prompting examination of both eyes using volumetric OCT imaging to determine whether there were palisades of Vogt (POV) present. Image volumes were acquired in all clock hours and were compared against those of an age-matched normal subject. Results Palisades were found in both eyes, although in both eyes there were fewer palisade ridges, and those that were present were not as distinct as those of the normal subject. The OCT volumes also showed that stromal scarring was present only in the anterior stroma of the intended transplant eye. These findings suggested that the patient may be able to sustain a deep anterior lamellar keratoplasty (DALK) without an autologous transplant, which would spare any insult to the opposing eye and require less surgery to restore vision in the affected eye. Nine months post-surgical follow up revealed significant improvement in visual acuity and no scar tissue development. Conclusion OCT evaluation of the POV provides detailed information to the clinician that may assist in diagnosis and evaluation of patients prior to transplantation. Further development of this technique is necessary to make it clinically available.

The diagnosis of limbal stem cell deficiency

“…2C) [120]. This technique may enhance targeted limbal biopsies for transplantation [121]. However, as mentioned above, the palisades of Vogt may be absent in eyes with normal LSC function.…”

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

“…2). However, in vivo laser scanning confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) facilitate greater accuracy in diagnosis and staging [31][32][33][34][35]. An international multidisciplinary working group on LSCD arrived at a staging system based on clinical features observed on biomicroscopy (Table 1) [11].…”

A Review of Limbal Stem Cell Deficiency

“…In addition, the limbal region and palisades of Vogt (POV) can be identified and evaluated in vivo. 37 The transition zone between the hyporeflective corneal epithelium and hyperreflective conjunctival epithelium can be distinguished with ASOCT. The most common limbal ASOCT characteristics seen in patients with LSCD include flattening of the stroma and thinner epithelium (cross sections parallel) and a complete flat profile to the limbal transition zone (cross sections perpendicular).…”