Alcohol delamination in the treatment of recurrent corneal erosion: an electron microscopic study
Alcohol delamination in the treatment of recurrent corneal erosion: an electron microscopic study
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DOI：
10.1136/bjo.2009.174409
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发表时间：
2010-07-01
影响因子：
4.1
通讯作者：
Romagnoli, Paolo
中科院分区：
文献类型：
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作者：
Mencucci, Rita;Paladini, Iacopo;Romagnoli, Paolo
目的通过电镜观察复发性角膜侵蚀综合征患者酒精分层（ALD）过程中上皮层与底物的分离平面。方法对10例外伤后复发性角膜糜烂（RCE）和7例图点指纹营养不良（MDFP）患者进行ALD治疗。通过透射电镜检查从这些患者身上获得的上皮片。同样，20例接受光屈光性角膜切除术的患者（10例机械切除，10例ALD切除）也获得了类似的薄片作为对照组。另外5个角膜移植获得的角膜钮扣用ALD处理，并检查上皮片和相应的基质。结果在所有标本中，无论是机械切除还是ALD切除，细胞间表面均未出现任何破坏，桥粒得以保存。在外伤性RCE患者和角膜成形术中获得的角膜钮扣中，沿透明层发生组织分离，而在MDFP患者中，整个基底层与上皮一起被移除。还注意到基底细胞变性和基底膜上皮脱离的局灶性区域。结论ALD能够有效地切除外伤性RCE的上皮，并几乎完整地保留了板层致密。在MDFP引起的RCE中，上皮从基底膜下的间质中分离出来，这可能反映了该疾病的病理情况。
Aim To investigate by electron microscopy the plane of separation of the epithelial sheet from its substratum in the procedure of alcohol delamination (ALD) in patients with recurrent corneal erosion syndrome.Methods Ten cases of recurrent corneal erosions (RCE) secondary to trauma and seven cases related to map-dot-fingerprint dystrophy (MDFP) were treated with ALD. The epithelial sheets obtained from these patients were examined by transmission electron microscopy. Similarly sheets obtained from 20 patients undergoing photorefractive keratectomy (10 by mechanical removal and 10 by ALD) were also examined as control group. Five further corneal buttons obtained at keratoplasty were treated with ALD and the epithelial sheet and corresponding stroma were both examined.Results In all specimens, whether removed mechanically or by ALD, the intercellular surfaces did not show any disruption and desmosomes were preserved. In patients with traumatic RCE and in corneal buttons obtained at keratoplasty, tissue separation occurred along the lamina lucida, whereas in patients with MDFP the whole basal lamina was removed along with the epithelium. Focal areas of basal cell degeneration and epithelial detachment from the basal lamina were also noted.Conclusions ALD enables efficient removal of the epithelium with an almost complete preservation of the lamina densa in traumatic RCE. In RCE due to MDFP the epithelium separates from the stroma below the basal lamina and may reflect the pathology of the condition.