Retrocorneal Membranes: A Comparative Immunohistochemical Analysis of Keratocytic, Endothelial, and Epithelial Origins
Retrocorneal Membranes: A Comparative Immunohistochemical Analysis of Keratocytic, Endothelial, and Epithelial Origins
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DOI：
10.1016/j.ajo.2010.03.011
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发表时间：
2010-08-01
影响因子：
4.2
通讯作者：
Bhat, Pooja
中科院分区：
文献类型：
--
作者：
Jakobiec, Frederick A.;Bhat, Pooja
目的：通过免疫组织化学方法确定角膜后细胞膜和纤维膜的来源。设计：采用手术切除的人角膜组织进行回顾性的临床病理研究。方法：回顾眼部疾病和手术治疗的临床记录。对5个去核对照球、32个穿透性角膜移植标本和6个Descemet剥离内皮角膜移植标本进行免疫组织化学染色，分析：(1)正常角膜上皮、基质和内皮细胞；(2)基质瘢痕、内皮异常和角膜后膜。石蜡切片用苏木精-伊红、高碘酸席夫和Masson三色法染色，并用常用的多种细胞角蛋白(CKs)、CD34、α-平滑肌肌动蛋白(SMA)和波形蛋白的单抗和多克隆抗体进行免疫组织化学分析。12例间质来源的纤维(角化细胞)膜胶原粗大，所有CKS免疫染色均为阴性，但波形蛋白和α-SMA呈强阳性，后者是唯一具有诊断价值的标记物。9个化生的内皮来源的膜产生精致的胶原基质，并与CK7、波形蛋白和α-SMA免疫反应。两种上皮多层膜或单层膜与CK鸡尾酒和广谱CK反应，与CK7轻度反应(在原位表面上皮中未见)，与α-SMA和波形蛋白阴性。最后两类为不确定或无免疫反应(3例)和混合性(2例)。结论：免疫组织化学在大多数病例中可以可靠地诊断不同来源的角膜后膜。临床相关性证实，这些膜在严重的炎症性疾病、长期的创伤或溃疡和多次手术(平均每名患者3.4次)后形成。《眼科杂志》2010；150：230-242。(C)2010年，爱思唯尔公司保留所有权利。)
PURPOSE: To determine through the use of immunohistochemistry the origins of retrocorneal cellular and fibrillar membranes.DESIGN: Retrospective, clinicopathologic study using surgically removed human corneal tissues.METHODS: Clinical records of patients' ocular diseases and surgical procedures were reviewed. Immunohistochemical staining was performed on 5 enucleated control globes, 32 penetrating keratoplasty specimens, and 6 Descemet stripping endothelial keratoplasty specimens to analyze: (1) the normal corneal epithelium, stroma, and endothelium; and (2) stromal scars, endothelial abnormalities, and retrocorneal membranes. Paraffin sections were stained with hematoxylin and eosin, periodic acid-Schiff, and Masson trichrome methods, and immunohistochemical analyses were performed with commonly available monoclonal and polyclonal antibodies for various cytokeratins (CKs), CD34, alpha-smooth muscle actin (SMA), and vimentin.RESULTS: Five subtypes among 28 retrocorneal membranes were characterized. Twelve fibrous (keratocytic) membranes of stromal origin had coarse collagen and immunostained negatively for all CKs, but strongly for vimentin and alpha-SMA, the last the only marker of diagnostic value. Nine metaplastic endothelium-derived membranes produced delicate collagenous matrices and immunoreacted with CK7, vimentin, and alpha-SMA. Two epithelial multilaminar or monolaminar membranes reacted with CK cocktail and wide-spectrum CK, mildly with CK7 (not observed in orthotopic surface epithelium), and negatively for alpha-SMA and vimentin. The final 2 categories were indeterminate or nonimmunoreactive (3 specimens) and mixed (2 specimens).CONCLUSIONS: Immunohistochemistry can diagnose retrocorneal membranes of different provenances reliably in most cases. Clinical correlations established that these membranes develop after serious inflammatory disorders, prolonged wounding or ulcerations, and multiple surgeries (an average of 3.4 per patient). (Am J Ophthalmol 2010; 150:230-242. (C) 2010 by Elsevier Inc. All rights reserved.)