Corona sign: manifestation of peripheral corneal epithelial edema as a possible marker of the progression of corneal endothelial dysfunction
Corona sign: manifestation of peripheral corneal epithelial edema as a possible marker of the progression of corneal endothelial dysfunction
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DOI：
10.1007/s10384-016-0459-8
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发表时间：
2016-09-01
影响因子：
2.4
通讯作者：
Ohashi, Yuichi
中科院分区：
文献类型：
--
作者：
Inoue, Tomoyuki;Hara, Yuko;Ohashi, Yuichi
描述电晕征的特征形式及其与角膜内皮失代偿程度的临床相关性，并使用兔模型研究其潜在机制。这些观察病例包括 31 名接受穿透性角膜移植术 (PKP) 的患者和 15 名接受后弹力层剥离自动内皮角膜移植术 (DSAEK) 的患者，特别注意圆周发展的角膜上皮水肿。我们还对兔角膜水平水流进行了实验室观察。在PKP后角膜内皮失代偿的初始阶段，我们始终观察到上周边的电晕征。随着角膜内皮细胞逐渐丧失，上皮水肿逐渐向周边扩展。与无电晕征相关的内皮细胞密度较无电晕征显着降低（P < 0.01）。与上冠征相比，环冠征病例的内皮细胞密度显着降低（P < 0.05）。然而，在 DSAEK 术后，角膜上皮水肿从中心消退，但在所有病例中仍持续存在于周边，呈电晕征。术后3个月，上皮水肿仅限于上周边，角膜内皮愈合顺利。家兔实验表明，角膜内皮完全失代偿减少了角膜周边的水平角膜内水分迁移（Inoue-Ohashi现象）并引起周边角膜水肿。裂隙灯显微镜下所发现的周边角膜的冠状上皮水肿与角膜内皮功能的阶段有关。为了支持这一点，通过实验证明了电晕征的发育机制。
To describe a characteristic form of the corona sign and its clinical relevance to the degree of corneal endothelial decompensation and investigate the underlying mechanism using a rabbit model.These observational cases include 31 patients undergoing penetrating keratoplasty (PKP) and 15 patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with special attention to the circumferentially developed corneal epithelial edema. We also conducted a laboratory observation of horizontal water flow in the rabbit cornea.We consistently observed the corona sign at the superior periphery during the initial stage of corneal endothelial decompensation after PKP. With progressive corneal endothelial cellular loss, the epithelial edema gradually expanded circumferentially in the periphery. The endothelial cellular density associated with the corona sign significantly (P < 0.01) decreased compared with that without the sign. The endothelial cellular density decreased significantly (P < 0.05) in cases with a circumferential corona sign compared with a superior corona sign. After DSAEK, however, the corneal epithelial edema subsided from the center but persisted peripherally as a corona sign in all cases. By 3 months postoperatively, the epithelial edema was confined to the superior periphery along with uneventful corneal endothelial healing. Rabbit experiments showed that total corneal endothelial decompensation decreased the horizontal intracorneal water migration (Inoue-Ohashi phenomenon) in the corneal periphery and induced peripheral corneal edema.The slit-lamp microscopic findings of the corona-like epithelial edema in the peripheral cornea are associated with the stage of corneal endothelial function. To support this, the developmental mechanism of the corona sign was demonstrated experimentally.