Limbal stem cell deficiency secondary to vitrectomy in the context of an autoimmune polyendocrine syndrome type
Bibliographic record
Abstract
Purpose: Autoimmune polyendocrine syndromes (APS) are rare diseases characterized by immunologic activity against multiple endocrine organs. Bilateral keratitis and limbal stem cell deficiency are manifestations described. Methods: A 28-year-old man presented to our service with discomfort in his left eye. Past medical history included autoimmune polyendocrine syndrome, under hormonal treatment. Ocular history included an idiopathic bilateral peripheral occlusive vascular retinal disease, with areas of non-perfusion, neovascularization, and bleeding, treated with laser photocoagulation. He presented with a vitreous hemorrhage which was treated with a 20-gauge pars plana vitrectomy and endolaser. On review of family history, the patient reported having an older brother also affected by APS, developing the same bilateral retinal affection. Results: Examination of the anterior segment of the left eye revealed a superior corneal epithelial irregularity. Fundus examination was significant for retinal arteries with segmental blood flow, box-carring, along with peripheral laser scars over previously ischemic areas. Corneal scraping and impression cytology demonstrated goblet cells on the corneal surface epithelium. A diagnosis of limbal stem cell insufficiency was made, and the patient was started on ocular lubricating drops and topical corticosteroids. At follow-up, the patient has been stable. Conclusions: We describe a case of iatrogenic limbal stem cell insufficiency related to vitrectomy in a patient with autoimmune polyendocrine syndrome, a risk factor for this presentation. We propose that surgical trauma near the limbus and damage to the corneal sub-basal nerve plexus during vitrectomy may result in the development of limbal stem cell deficiency in a predisposed eye, as postulated in this patient with an APS.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".