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Case Study: August 2009
History
A 45 year old man presents to the eye clinic with a corneal opacity. On examination there is a fibro-vascular pannus covering the cornea. There is a history of chemical injury some years back.
A corneal impression is taken with an impression disc under local anaesthetic, being careful not to contaminate it with conjunctival epithelium.
Fig 1 is a CK 19 immuno of the impression
Fig 2 is a PAS stain of the impression
Questions
1. What do figures 1 and 2 show?
2. What is the implication of these findings?
1. Presence of CK19 positive ‘conjunctival phenotype’ cells on the corneal surface including goblet cells.
2. This implies conjunctivilisation of the corneal surface indicative of limbal stem cell failure.
The patient went on to undergo a successful autologous limbal stem cell graft.
