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Central corneal basal cell density and nerve parameters in ocular surface disease and limbal stem cell deficiency: a review and meta-analysis
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  • Published on:
    Response to the e-letter to editor by Bonnet et al on “The Central corneal basal cell density and nerve parameters in ocular surface disease and limbal stem cell deficiency: a review and meta-analysis”.

    To the Editor,

    We appreciate the authors' interest in our study. In their letter to the editor regarding our meta-analysis[1], the authors raise an issue regarding the inclusion of the diseases in the two groups i.e. limbal stem cell deficiency (LSCD) and ocular surface disease (OSD). We adhered to the categorization of the diseases as indicated or mentioned in the publications which were included in the meta-analysis. Our literature search based on combinations of various “key-words” or “key-terms” returned results as depicted in the categorization of the diseases in the study.[2,3] LSCD being a sub-set of OSD, has signs and symptoms in common with many other conditions, hence it was important that the term “limbal stem cell deficiency” appeared in the publications for the study participants to be categorized into the LSCD group.[2,3,4]

    The lack of consideration of the severity of LSCD and OSD was unavoidable due to the limited data within the source publications. It is apparent that the severity of the disease may affect the corneal epithelial basal cell density (BCD) and nerve fibre parameters.[5,6] The lack of data is likely explained by the difficulty in imaging in the more severe disease when corneal transparency is reduced; the corneal basal cells and nerves are difficult to image using confocal microscopy when the cornea is not clear. This is an important factor which is highlighted in our study.[1] Furthermore, our analysis did not attempt to c...

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    Conflict of Interest:
    None declared.
  • Published on:
    Letter to the Editor

    To the Editor,
    We read with great interest the article entitled “Central corneal basal cell density and nerve parameters in ocular surface disease and limbal stem cell deficiency: a review and meta-analysis”. In the analysis, the authors found a similar reduction of basal cell density (BCD) and corneal nerve parameters between the limbal stem cell deficiency (LSCD) group and the ocular surface disorders (OSD) group. However, several missteps in the study methods occurred.
    First, the analysis included ocular diseases that could lead to LSCD in the OSD group (eg, severe and chronic vernal and atopic keratoconjunctivitis, bullous keratopathy, and ocular graft-versus-host disease).[1] Second, acute microbial infectious keratitis, which is generally not considered as an OSD because of its distinct pathology, was included in the OSD group. Third, the severity of LSCD and OSD was not considered in the analysis. As previously demonstrated, the decrease in BCD and basal nerve density is positively correlated with LSCD severity.[2 3] Fourth, the overall sample size was very small. Lastly, no sensitivity/meta-regression analysis was done despite the significant heterogeneity in the OSD group.
    We repeated the analysis after removing 7 studies wrongly included into the OSD group (Al-Aqaba &al, Leonardi &al, Muller &al -2 reports-, Moein &al, Cavalcanti &al, Tepelus &al) and not including them in the LSCD group because of heterogeneity of the st...

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    Conflict of Interest:
    None