Infectious Keratitis in Severe Limbal Stem Cell Deficiency: Characteristics and Risk Factors

Abstract

Purpose: To evaluate the incidence, clinical and microbiological characteristics and risk factors of infectious keratitis in patients with limbal stem cell deficiency (LSCD).

Methods: Retrospective comparative case series of 35 patients with severe LSCD.

Results: The mean follow-up time was 46 months. Infectious keratitis were mainly caused by Gram positive bacteria (94%). Only 7 infections (37%) healed under fortified adapted antibiotics. In 8 cases (42%), amniotic membrane transplantation was required and in 4 cases (21%) «à chaud» keratoplasty was performed. Significant risk factors associated with infectious keratitis were: soft contact lens extended wear, history of persistent epithelial defects, number of quadrants of corneal vascularization, re-epithelialization time after amniotic membrane or corneal transplantation, and use of corticosteroid or cyclosporin eye drops.

Conclusion: Infectious keratitis in LSCD is frequent and severe. The restoration of the epithelial barrier integrity and a careful use of therapeutic contact lenses may help to prevent infection.

Keywords::

• limbal stem cell
• deficiency
• keratitis
• risk factors
• characteristics

ACKNOWLEDGEMENTS

a.	Funding/Support: This study was supported by Pierre & Marie Curie University Paris 06, Paris, France.
b.	Financial Disclosures: The authors have no proprietary, commercial or financial interests in any of the products described in this study. They have no conflict of interest.
c.	Contributions of Authors: Design of the study (VMB); Conduct of the study (OS, VMB); Collection of the data (OS, TG, PG, DGB); Management of the data (VMB, OS); Analysis of the data (OS, VMB); Interpretation of the data (PG, LL); Preparation of the manuscript (OS, VMB); Review and approval of the manuscript (TG, PG, DGB, LL).
d.	Statement and Conformity with Author Information: The study was submitted to the Ethical Committee of the French Society of Ophthalmology which waived approval because no modifications to French standards of treatment or follow-up were made. The study and data accumulation were in conformity with all French laws, informed consent was obtained, and the study was in adherence to the tenets of the Declaration of Helsinki.
e.	Other Acknowledgments: None.

Declaration of interest: The authors declare no conflicts of interest.