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Presentation type	E-poster
Title	Inherited Limbal Stem Cell Deficiency as the Presenting Feature of PAX6-Related Aniridia

Purpose	To describe a rare case of inherited bilateral limbal stem cell deficiency (LSCD) leading to the diagnosis of PAX6-related aniridia despite the presence of a visible iris.
Methods	A 24-year-old woman with congenital nystagmus, bilateral keratoconus and longstanding low vision was referred for a second opinion regarding corneal neovascularisation and suspected LSCD. She had undergone bilateral epi-off corneal cross-linking in 2016 and subsequently wore scleral lenses. Slit-lamp examination, macular OCT, full-field ERG and targeted PAX6 analysis were performed.
Results	Visual acuity was 0.15 OD and 0.08 OS. Slit-lamp examination showed bilateral peripheral corneal neovascularisation, central fibrosis and inferior iris transillumination. Macular OCT demonstrated foveal hypoplasia OD; no reliable scan was obtained OS. Full-field ERG was mildly abnormal but not clearly pathological. Genetic testing identified a de novo heterozygous pathogenic PAX6 frameshift variant, c.1051del, p.(Met351TrpfsTer28), confirming PAX6-related aniridia with aniridia-associated keratopathy.
Conclusion	PAX6-related aniridia represents a phenotypic spectrum and does not require complete iris absence. In young patients with bilateral LSCD, congenital nystagmus and unexplained low vision, subtle iris abnormalities and foveal hypoplasia should prompt consideration of PAX6-related disease.
Conflict of interest	No

Authors 1

Last name	TALLAL
Initials	S
Department	Vrije Universiteit Brussel
City	Jette

Authors 2

Last name	Bleyen
Initials	I
Department	AZ Monica
City	Deurne

Authors 3

Last name	Ní Dhubhghaill
Initials	S
Department	UZ Brussel
City	Jette