Effect of Combined Rebamipide and Cyclosporine Therapy in Limbal Stem Cell Deficiency Caused by Long-term Soft Contact Lens Wear

Purpose: To evaluate the clinical outcomes of combined aggressive nonsurgical treatments, including combined rebamipide and cyclosporine therapy, in patients with stage IIb limbal stem cell deficiency (LSCD) induced by long-term silicone hydrogel contact lens wear.Methods: A retrospective case series analysis was conducted on four eyes of three patients with stage IIb LSCD with a history of prolonged contact lens wear, who were refractory to artificial tears and other conventional conservative treatments for at least 1 month. Contact lens use was discontinued in all the patients, and topical rebamipide and cyclosporine were administered in combination. Changes in the best-corrected visual acuity, corneal epithelial stability, degree of corneal conjunctivalization, and superficial corneal neovascularization were evaluated before and after treatment.Results: All patients demonstrated improved corneal epithelial stability after combination therapy. The progression of corneal epithelial opacity and conjunctivalization was suppressed, and a marked improvement in visual acuity was observed in some cases. No significant drug-related adverse events were observed during the treatment period.Conclusions: Aggressive nonsurgical treatment, including combined topical therapy with rebamipide and cyclosporine, topical steroids, and supportive treatment, may be an effective treatment option for patients with stage IIb contact lens–induced LSCD who are unresponsive to artificial tear–based conservative management. This strategy may be considered before surgical intervention in selected patients with stage IIb LSCD in whom the residual limbal function is preserved.