Abstract
Subepithelial fibrosis (SEF) and the transdifferentiation of keratocytes into fibroblasts or myofibroblasts (Fbs/MFbs) have been detected in the cornea of individuals with bullous keratopathy. We examined the anterior cornea of bullous keratopathy patients for such changes after Descemet’s stripping automated endothelial keratoplasty (DSAEK). Twenty-two individuals who underwent unilateral DSAEK at Yamaguchi University Hospital were enrolled in the study. The subjects were divided into groups A (n = 10) and B (n = 12) with a preoperative duration of stromal edema of less than or at least 12 months, respectively. The structure of the anterior stroma was examined by in vivo laser confocal microscopy at various times after surgery. SEF was detected in 1 (10.0%) and 11 (91.7%) cases in groups A and B, respectively, before surgery as well as in 0 (0%) and 7 (58.3%) cases, respectively, at 6 months after DSAEK. Fb/MFb transdifferentiation was detected in 0 (0%) and 8 (66.7%) cases in groups A and B, respectively, before surgery as well as in 0 and 1 (8.3%) case, respectively, at 6 months postsurgery. Anterior stromal scattering (ASS) was detected in 10 (100%) and 12 (100%) cases in groups A and B, respectively, before surgery as well as in 0 (0%) and 6 (50.0%) cases, respectively, at 6 months after DSAEK. Changes in anterior stromal structure apparent before surgery were thus also detected in bullous keratopathy patients after DSAEK. SEF and ASS persisted for more than 6 months in a substantial proportion of individuals with a preoperative duration of stromal edema of at least 12 months.
Highlights
Endothelial keratoplasty such as Descemet’s stripping automated endothelial keratoplasty (DSAEK) [1,2,3,4] or Descemet’s membrane endothelial keratoplasty [5,6,7] is being increasingly adopted for the surgical treatment of bullous keratopathy, with the number of such procedures performed being greater than that for penetrating keratoplasty in some countries [8,9]
Our observations revealed a structural abnormality beneath the basal cell layer of the corneal epithelium, designated subepithelial fibrosis (SEF) [14], that was detectable by second harmonic generation imaging microscopy [15,16]
We found that SEF and Fb/MFb transdifferentiation were detectable after surgery, especially in individuals with a long preoperative duration of stromal edema, and that the frequency of these signs decreased with time after surgery
Summary
Endothelial keratoplasty such as Descemet’s stripping automated endothelial keratoplasty (DSAEK) [1,2,3,4] or Descemet’s membrane endothelial keratoplasty [5,6,7] is being increasingly adopted for the surgical treatment of bullous keratopathy, with the number of such procedures performed being greater than that for penetrating keratoplasty in some countries [8,9]. A common factor related to the expression of these pathological changes as well as to postoperative visual acuity after DSAEK in bullous keratopathy cases was found to be the duration of stromal edema, which can lead to the development of Descemet’s folds or epithelial edema [15,16,17,19]. The presence of such pathological structural alterations in individuals with bullous keratopathy is an important consideration with regard to the performance of DSAEK surgery
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