Limbal stem cell deficiency after glaucoma surgery differs from deficiency after chemical injury
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Patients with limbal stem cell deficiency after glaucoma surgery typically experienced only epithelial changes and no corneal neovascularization, which differs from limbal stem cell deficiency resulting from chemical injury or ocular surface inflammation, according to a study.
“In a retrospective study of 51 eyes, Sun et al found that glaucoma surgery, including trabeculectomy and tube shunt implantation, was associated with limbal stem cell deficiency. The involved quadrants of limbal stem cell deficiency closely correlated with the location of glaucoma surgery but not with other limbal-involving surgeries such as endothelial keratoplasty or cataract extraction,” study co-author Sophie X. Deng, MD, PhD, told Healio/OSN.
The retrospective cross-sectional study included 51 eyes of 41 patients with glaucoma who underwent trabeculectomy and/or aqueous tube shunt surgery. Researchers compared the anatomic locations of glaucoma and non-glaucoma surgeries, locations of limbal stem cell deficiency (LSCD) and severity of LSCD.
The type and location of glaucoma surgery, the number of surgeries, the number of trabeculectomies and/or drainage devices, and the use of mitomycin C and/or 5-fluorouracil were obtained through chart review. Patients with LSCD were identified on clinical examination and stratified into a single glaucoma surgery group or two or more glaucoma surgeries group.
“Sun et al also established a unique phenotype of LSCD after glaucoma surgery, characterized by sectoral LSCD (in the surgical quadrant) without corneal neovascularization or pannus, which is clinically distinct from LSCD resulting from chemical injury or ocular surface inflammation,” Deng said.
The glaucoma surgery locations strongly correlated with the LSCD locations (P = .002). The superior limbus was the most affected region, followed by the temporal and nasal limbus regions.
While there was a trend of increased LSCD severity in patients with two or more glaucoma surgeries vs. those who underwent one glaucoma surgery, the difference was not statistically significant.
“These findings underscore the importance of ocular surface management in glaucoma patients through the judicious use of antimetabolites, minimization of surgical trauma, reduce the exposure to preservative in eye medications and postoperative care,” Deng said.
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