Myofibroblast Metaplasia After Descemet Membrane Endothelial Keratoplasty
Myofibroblast Metaplasia After Descemet Membrane Endothelial Keratoplasty
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DOI：
10.1016/j.ajo.2010.11.032
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发表时间：
2011-06-01
影响因子：
4.2
通讯作者：
Kruse, Friedrich E.
中科院分区：
文献类型：
--
作者：
Heindl, Ludwig M.;Schloetzer-Schrehardt, Ursula;Kruse, Friedrich E.
目的：描述2例角膜内皮膜角膜移植术（DMEK）后角膜内皮细胞完全粘附的视功能受损患者角膜内皮细胞肌成纤维化。设计：介入性病例系列。方法：在连续90例DMEK手术中，有2例术后6个月角膜仍未清除，尽管移植体完全附着。二次穿透性角膜移植术后，用组织病理学分析和透射电镜检查两个角膜按钮。结果：光镜显示明显的角膜内皮细胞衰减，存在异常的后胶原层。其余大多数内皮细胞呈细长的成纤维细胞样外观，a-平滑肌肌动蛋白免疫阳性，表明肌成纤维细胞化生。透射电子显微镜下可见稍增厚的内皮膜，后纤维胶原层异常，剩余内皮细胞呈肌成纤维样转化。内皮膜移植物与宿主角膜基质的胶原层紧密相连，类似于正常角膜的内皮膜基质界面。结论：尽管Descemet膜内皮角膜移植术（DMEK）后角膜内皮细胞完全粘附，但减弱的角膜内皮细胞肌成纤维化生并形成异常的后胶原层可能导致视觉功能受损。[J]中华眼科杂志，2011;51(1):1 - 3。(C)爱思唯尔公司2011。版权所有。)
PURPOSE: To describe myofibroblastic metaplasia of corneal endothelial cells in 2 cases with impaired visual function despite complete graft adherence after Descemet membrane endothelial keratoplasty (DMEK).DESIGN: Interventional case series.METHODS: In 2 of 90 consecutive DMEK surgeries, the cornea failed to clear up to 6 months postoperatively despite complete graft attachment. After secondary penetrating keratoplasty, both corneal buttons were examined using histopathologic analysis and transmission electron microscopy.RESULTS: Light microscopy revealed distinct corneal endothelial cell attenuation with the presence of an abnormal posterior collagenous layer in both cases. Most of the remaining endothelial cells had an elongated fibroblast-like appearance with immunopositivity for a-smooth muscle actin indicative of myofibroblast metaplasia. Transmission electron microscopy showed a slightly thickened Descemet membrane with an abnormal posterior fibrillar collagenous layer and a myofibroblast-like transformation of the remaining endothelial cells. Descemet membrane grafts closely adjoined the collagen lamellae of the host corneal stroma similar to the Descemet membrane stroma interface of a normal cornea.CONCLUSION: Myofibroblastic metaplasia of attenuated corneal endothelial cells with formation of an abnormal posterior collagenous layer may contribute to an impaired visual function despite complete graft adherence after Descemet membrane endothelial keratoplasty (DMEK). (Am J Ophthalmol 2011;151:1019-1023. (C) 2011 by Elsevier Inc. All rights reserved.)