Abstract
PurposeTo evaluate histological changes in the corneal stroma in pseudophakic bullous keratopathy.MethodsTwenty-eight patients (28 eyes) with pseudophakic bullous keratopathy underwent therapeutic penetrating keratoplasty at Shandong Eye Institute between January 2006 and November 2011. The patients were divided into two groups according to the duration of bullous keratopathy (<1.0 year group or >1.0 year group), and three buttons from enucleated eyes with choroidal melanoma served as a control. In vivo confocal microscopy examination, hematoxylin–eosin, Masson's trichrome stain and Van Gieson staining were used for microscopic examination. The histological evaluation and scoring of the buttons for morphological changes, including the degree of stromal scars, neovascularization and inflammatory cells within the corneal buttons, were compared. To study the underlying mechanism, connective tissue growth factor (CTGF) and TGF-β immunohistochemistry were performed.ResultsConfocal microscopy examination and histological evaluation and scoring of the buttons showed that compared with the <1.0 year group, stromal scars, neovascularization and inflammatory cells were more severe in the >1.0 year group (P<0.05). There was an increase in CTGF- and TGF-β1-positive stromal cells in the >1.0 year group.ConclusionsDuring the progression of pseudophakic bullous keratopathy, stromal scars occurred more often in the patients that had a longer duration of disease. Cytokines such as CTGF and TGF-β1 may play a role in this pathological process and deserve further investigation.
Highlights
Pseudophakic bullous keratopathy has recently emerged as a leading cause of endothelial keratoplasty (EK)
EK maintains most of the corneal structure and the integrity of the eye as a result of a small incision, no sutures and rapid recovery; it is increasingly becoming the preferred method for treating bullous keratopathy [1,2,3]
The best ocular vision was significantly increased after penetrating keratoplasty, and the intraocular pressure remained stable during the follow-up period
Summary
Pseudophakic bullous keratopathy has recently emerged as a leading cause of endothelial keratoplasty (EK). In patients with a long duration of bullous keratopathy, EK cannot produce good vision because of the intense corneal stromal scars and neovascularization; penetrating keratoplasty should be used [4,5,6]. During the development of pseudophakic bullous keratopathy, there are pathological changes in the corneal stroma, such as scar formation, the proliferation of a collagenous layer and fibrillar material deposits. An abnormal proliferation of the posterior collagenous layer and a significantly lower keratocyte density was found in the posterior part of the stroma of patients with long-term pseudophakic bullous keratopathy [7]. It has been reported that abnormal fibrillar materials posterior to Descemet’s membrane and subepithelial fibrocellular materials disrupt the epithelial basement membrane and Bowman’s layer in the corneas of bullous keratopathy patients [8]
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