Limbal Stem Cell Deficiency After Treatment of Ocular Surface Squamous Neoplasia.

PURPOSE: To investigate limbal stem cell deficiency (LSCD) in patients surgically treated for ocular surface squamous neoplasia (OSSN).

METHODS

This retrospective case-control study investigated clinical and histological data from patients with OSSN surgically treated in a referral center.

RESULTS

The study included 98 patients (58 male, 40 female) with a mean age of 61.1 (23-86) years. Less than 3 clock hours were involved by OSSN in 48 eyes (49.0%), 3-6 clock hours in 32 eyes (32.7%), 6-9 clock hours in 12 eyes (12.2%), and more than 9 clock hours in 6 eyes (6.1%). Limbal stem cell deficiency was identified in 36 patients (36.7%) after surgery. The severity of LSCD was mild in 17 eyes, moderate in 11, and severe in 8. The prevalence of LSCD increased significantly in groups with 6 clock hours or more of OSSN involvement ( p < 0.001). The affected limbal side (superior, inferior, nasal, or temporal) had no significant association with the prevalence of LSCD ( p = 0.869). Patients with recurrent OSSN had a higher LSCD prevalence ( p = 0.003). The higher the tumor stage, the more likely it was to develop LSCD ( p < 0.001). Patients with corneal involvement were also more likely to develop LSCD ( p = 0.021). The prevalence of LSCD was raised with increasing histopathological grade ( p = 0.019). Furthermore, solely the number of clock hours affected by OSSN was an independent risk factor in multivariate analyses ( p < 0.001).

CONCLUSIONS

The size and severity of OSSN and the presence of recurrent OSSN are associated with an increased likelihood of developing LSCD. Furthermore, the extent of the limbal area involved by the OSSN is identified as an independent risk factor of the development of LSCD.