Risk Factors for Development of Limbal Stem Cell Deficiency After Acute Ocular Burns.

Abstract

Purpose: To identify the risk factors predictive of limbal stem cell deficiency (LSCD) in eyes with acute ocular burns (AOB).

Methods: This was a retrospective, comparative case series which included 112 eyes of 96 patients with AOB of severity > Dua grade II who had follow-up until complete epithelization. Data on injury details, clinical features, and treatment were collected. Logistic regression analysis was performed to identify risk factors for (i) LSCD following AOB, (ii) LSCD >6 clock hours, and (iii) LSCD requiring surgical intervention.

Results: Of the 112 eyes, 61 eyes (54%) of 56 patients developed LSCD. The final median best-corrected visual acuity (BCVA) was poorer in eyes with LSCD [logMAR 0.9 (IQR: 0.5-1.5)] when compared to the non-LSCD group [logMAR 0.1 (IQR: 0-0.3); p < .00001]. Regression analysis revealed lime injury (OR: 7.5, p = .002), conjunctival defect of >50% area (OR = 7.6, p = .0001), limbal epithelial defect of >6 clock hours (OR = 3.5, p = .02), and undergoing repeat AMT (OR: 15.3, p = .01) to be risk factors for the development of LSCD. For "LSCD of >6 clock hours", both conjunctival defect of >50% area [OR: 4.5 (CI: 1.2-16.9), p = .03] and limbal epithelial defect of >6 clock hours [OR: 9.6 (CI: 1.9-48.6), p = .006] were significant risk factors; while for the outcome "LSCD necessitating a surgical intervention", conjunctival defect of >50% area [OR: 4.1 (CI: 1.2-13.6), p = .03] was a risk factor.

Conclusions: Patients with lime injury, limbal epithelial defects, and conjunctival epithelial defects involving a larger area are at a higher risk of development of LSCD post AOB. Larger conjunctival defects indicate the development of more severe LSCD and a greater need for surgical intervention. Eyes with LSCD have poorer visual outcomes. Thus, preventing this entity by addressing the risk factors can alleviate the socioeconomic burden on the affected individuals and the healthcare system.