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In vivo morphology of the limbal palisades of vogt correlates with progressive stem cell deficiency in aniridia-related keratopathy.
[aniridia]
To
investigate
morphologic
alterations
in
the
limbal
palisades
of
Vogt
in
a
progressive
form
of
limbal
stem
cell
deficiency
.
Twenty
Norwegian
subjects
(
40
eyes
)
with
congenital
aniridia
and
9
healthy
family
members
(
18
eyes
)
without
aniridia
were
examined
.
Clinical
grade
of
aniridia
-related
keratopathy
(
ARK
)
was
assessed
by
slit-lamp
biomicroscopy
,
and
tear
production
and
quality
,
corneal
thickness
,
and
sensitivity
were
additionally
measured
.
The
superior
and
inferior
limbal
palisades
of
Vogt
and
central
cornea
were
examined
by
laser
scanning
in
vivo
confocal
microscopy
(
IVCM
)
.
In
an
aniridia
patient
with
grade
0
ARK
,
a
transparent
cornea
and
normal
limbal
palisade
morphology
were
found
.
In
grade
1
ARK
,
5
of
12
eyes
had
degraded
palisade
structures
.
In
the
remaining
grade
1
eyes
and
in
all
20
eyes
with
stage
2
,
3
,
and
4
ARK
,
palisade
structures
were
absent
by
IVCM
.
Increasing
ARK
grade
significantly
correlated
with
reduced
visual
acuity
and
corneal
sensitivity
,
increased
corneal
thickness
,
degree
of
degradation
of
superior
and
inferior
palisade
structures
,
reduced
peripheral
nerves
,
increased
inflammatory
cell
invasion
,
and
reduced
density
of
basal
epithelial
cells
and
central
subbasal
nerves
.
Moreover
,
limbal
basal
epithelial
cell
density
and
central
corneal
subbasal
nerve
density
were
both
significantly
reduced
in
aniridia
compared
to
healthy
corneas
(
P
=
0
.
002
and
0
.
003
,
respectively
)
.
Progression
of
limbal
stem
cell
deficiency
in
aniridia
correlates
with
degradation
of
palisade
structures
,
gradual
transformation
of
epithelial
phenotype
,
onset
of
inflammation
,
and
a
corneal
nerve
deficit
.
IVCM
can
be
useful
in
monitoring
early
-
to
late
-
stage
degenerative
changes
in
stem
cell-
deficient
patients
.
Diseases
Validation
Diseases presenting
"deficient patients"
symptom
aniridia
classical phenylketonuria
congenital toxoplasmosis
erythropoietic protoporphyria
homocystinuria without methylmalonic aciduria
neonatal adrenoleukodystrophy
omenn syndrome
phenylketonuria
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
zellweger syndrome
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