Spectral-domain Optical Coherence Tomography in Limbal Stem Cell Deficiency. A Case-Control Study.

PURPOSE: To evaluate the efficacy of optical coherence tomography (OCT) as a noncontact method for imaging the ocular surface in limbal stem cell deficiency (LSCD) and normal eyes. DESIGN: Retrospective case-control study. METHODS: Setting: Institutional. STUDY POPULATION: Twenty-two eyes with LSCD (study group, 22 patients) and 10 normal eyes (control group, 10 patients). OBSERVATION PROCEDURES: Spectral-domain (SD)-OCT and confocal microscopy in both the limbal and central corneal zones. MAIN OUTCOME MEASURES: Pachymetry data from the central cornea, presence of the palisades of Vogt, limbal crypts, and clear transition between the hyporeflective corneal epithelium and the hyperreflective conjunctival epithelium assessed on cross sections parallel and perpendicular to the limbus and en face sections of the limbal region. Parallel, perpendicular, and en face limbal scores were calculated by adding results of the 4 limbal quadrants. RESULTS: Both the difference between the minimal and the maximal epithelial thicknesses and the epithelial thickness standard deviation were significantly higher in the study group (mean, 47 µm/10 µm) compared with the control group (mean, 8 µm/2 µm). The parallel, perpendicular, and en face limbal scores were significantly lower in the study group (0.1/0.6/0.2) compared with the control group (7.4/4.8/3.5). Poorer visual acuity was significantly associated with higher standard deviation and difference between minimal and maximal corneal epithelial thicknesses (rs, +0.81/+0.77) and lower parallel, perpendicular, and en face limbal scores (-0.82/-0.73/-0.82). CONCLUSIONS: SD-OCT of both the central cornea and limbus with various section orientations is a valuable imaging modality allowing noninvasive and rapid overall precise assessment of both normal and LSCD eyes.