Sacchetti Marta, Lambiase Alessandro, Cortes Magdalena, Sgrulletta Roberto, Bonini Sergio, Merlo Daniela, Bonini Stefano
Interdisciplinary Center for Biomedical Research (CIR) Laboratory of Ophthalmology, University of Rome Campus Bio-Medico, Rome, Italy.
Graefes Arch Clin Exp Ophthalmol. 2005 Sep;243(9):870-6. doi: 10.1007/s00417-005-1159-0. Epub 2005 Mar 19.
To evaluate and relate the clinical (including corneal sensitivity and tear function) and cytological (presence of goblet cells and cytokeratin 3- and 19-positive cells) features of limbal stem cell deficiency (LSCD).
Twenty-nine patients (44 eyes) with a clinical diagnosis of LSCD participated in this study. Corneal signs (epithelial alterations, superficial neovascularisation and stromal scarring) and cytological findings (presence of goblet cells and cytokeratins 3 and 19) were evaluated and scored (from 0 to 3) from each of the five corneal sectors. Corneal sensitivity (Cochet-Bonnet aesthesiometer) and tear function (Schirmer test and BUT) were also assessed. Cytological scores were correlated statistically with both corneal signs and sensitivity values.
Cytokeratin 19-positive cells were found in 82% of corneal impression cytology samples, while goblet cells were identified in only 59% of these same samples. Cytokeratin 3-positive cells were present in 61% of LSCD eyes and in all unaffected eyes. Corneal sensitivity was significantly decreased in affected eyes compared with contralateral, healthy eyes (1.6+/-1.7 cm versus 5.7+/-0.3 cm). Tear function tests did not show significant changes. In LSCD eyes, goblet cells and cytokeratin 19-positive cells on the corneal surface were significantly correlated to corneal epithelial alterations and to corneal superficial neovascularisation (p<0.001). Corneal cytokeratin 3-positive cells were inversely related to epithelial alterations (p=0.003). Corneal sensitivity was decreased in corneal sectors with epithelial alterations (p<0.001), neovascularisation (p<0.001) and stromal abnormalities (p=0.049), and was indirectly related to the presence of goblet cells (p=0.005) and cytokeratin 19-positive cells (p<0.001).
This study confirmed the importance of cytological tests in the diagnosis of LSCD. Furthermore, the absence of goblet cells may not exclude corneal conjunctivalisation as demonstrated by cytokeratin 19 immunostaining. Lastly, corneal conjunctivalisation was associated with zone-specific impairment in corneal sensitivity.
评估角膜缘干细胞缺乏（LSCD）的临床特征（包括角膜敏感性和泪液功能）与细胞学特征（杯状细胞及细胞角蛋白3和19阳性细胞的存在情况），并分析两者之间的关系。
29例临床诊断为LSCD的患者（44只眼）参与了本研究。对五个角膜象限的角膜体征（上皮改变、浅层新生血管形成和基质瘢痕）和细胞学检查结果（杯状细胞及细胞角蛋白3和19的存在情况）进行评估并评分（0至3分）。同时评估角膜敏感性（使用Cochet - Bonnet触觉计）和泪液功能（Schirmer试验和泪膜破裂时间）。细胞学评分与角膜体征及敏感性数值进行统计学相关性分析。
在82%的角膜印片细胞学样本中发现细胞角蛋白19阳性细胞，而在这些相同样本中仅59%鉴定出杯状细胞。61%的LSCD眼及所有未受影响的眼中存在细胞角蛋白3阳性细胞。与对侧健康眼相比，患眼的角膜敏感性显著降低（1.6±1.7 cm对5.7±0.3 cm）。泪液功能检查未显示显著变化。在LSCD眼中，角膜表面的杯状细胞和细胞角蛋白19阳性细胞与角膜上皮改变及角膜浅层新生血管形成显著相关（p<0.001）。角膜细胞角蛋白3阳性细胞与上皮改变呈负相关（p = 0.003）。角膜上皮改变（p<0.001）、新生血管形成（p<0.001）和基质异常（p = 0.049）的角膜象限中角膜敏感性降低，且与杯状细胞（p = 0.005）和细胞角蛋白19阳性细胞（p<0.001）的存在间接相关。
本研究证实了细胞学检查在LSCD诊断中的重要性。此外，如细胞角蛋白19免疫染色所示，杯状细胞的缺失可能并不排除角膜结膜化。最后，角膜结膜化与角膜敏感性的区域特异性损害相关。
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