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Impression cytology findings in bullous keratopathy
  1. Fabiana dos Santos Paris,
  2. Eliana Domingues Gonçalves,
  3. Jeison de Nadai Barros,
  4. Mauro Silveira de Queiroz Campos,
  5. Élcio Hideo Sato,
  6. José Álvaro Pereira Gomes
  1. Eye Disease Laboratory, Federal University of São Paulo, Brazil
  1. Correspondence to Dr Fabiana dos Santos Paris, Federal University of São Paulo, Av. Pedro de Toledo, 760/94, Marília-SP 17509-020, Brazil; dra{at}


Aim To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK).

Design Cross-sectional observational case series.

Methods IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas.

Results Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822).

Conclusion Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.

  • Impression cytology
  • goblet cell
  • bullous keratopathy
  • neovascularisation
  • squamous metaplasia
  • cornea
  • stem cells
  • neovascularisation

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  • Funding FAPESP http://www.fapesp.brR. Pio XI, 1500, Alto da Lapa -CEP 05468-901, São Paulo/SP, Brazil.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethics Committee of the Federal University of São Paulo, São Paulo, Brazil.

  • Provenance and peer review Not commissioned; externally peer reviewed.