Resch Miklós D, Schlötzer-Schrehardt Ursula, Hofmann-Rummelt Carmen, Sauer Renate, Cursiefen Claus, Kruse Friedrich E, Beckmann Matthias W, Seitz Berthold
1st Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
Invest Ophthalmol Vis Sci. 2006 May;47(5):1853-61. doi: 10.1167/iovs.05-0983.
The aim of this study was to investigate the structural relationship between integrated amniotic membrane (AM) and corneal tissues in various integration patterns, focusing on adhesion structures along the interface.
Fourteen eyes of 14 patients (age, 65.8 +/- 13.5 years) underwent penetrating keratoplasty (PKP) 19.3 +/- 20.7 weeks after cryopreserved human AM transplantation (AMT). The corneal buttons (after PKP) and the corresponding original AM (before AMT) were examined with the use of transmission electron microscopy (TEM) and immunohistochemistry for integrin beta4, type VII collagen, and laminin. Main outcome measures included thickness of the corneal epithelium and AM, density of the epithelial desmosomes and hemidesmosomes, continuity, and thickness of the epithelial basement membrane.
Integrated AM was found by slit lamp in only 2 of 14 patients, but histology and TEM revealed AM integration in 11 of 14 patients up to 77 weeks after AMT. No amniotic epithelial cell was detected in any cornea with integrated AM stroma. Three basic patterns of integration could be described: subepithelial, intraepithelial, and intrastromal. Hemidesmosomes anchored the corneal epithelial cells to the AM at a density up to 165.3 +/- 22.9 per 100 microm cell membrane length. Discontinuous basement membrane segments 17.2 +/- 4.9 nm thick could be detected. Desmosomes among recovered corneal epithelial cells were found at a density of 21.2 +/- 5.3 per 10 microm cell membrane length.
The AM stroma can integrate into the host corneal tissue. Integration is associated with the formation of adhesion structures such as hemidesmosomes and desmosomes, which provide anchoring and stability of the regenerating corneal epithelium. The presence of integrated AM and adhesion structures with host corneal tissue supports the clinical experience obtained with AMT in ocular surface disease.
本研究旨在探讨不同整合模式下羊膜（AM）与角膜组织之间的结构关系，重点关注界面处的黏附结构。
14例患者（年龄65.8±13.5岁）的14只眼在冷冻保存的人羊膜移植（AMT）后19.3±20.7周接受了穿透性角膜移植术（PKP）。对角膜植片（PKP术后）和相应的原始羊膜（AMT术前）进行透射电子显微镜（TEM）检查及整合素β4、VII型胶原和层粘连蛋白的免疫组织化学检测。主要观察指标包括角膜上皮和羊膜的厚度、上皮桥粒和半桥粒的密度、连续性以及上皮基底膜的厚度。
裂隙灯检查发现仅14例患者中的2例存在整合的羊膜，但组织学和TEM显示14例患者中有11例在AMT后长达77周时存在羊膜整合。在任何有整合羊膜基质的角膜中均未检测到羊膜上皮细胞。可描述出三种基本的整合模式：上皮下、上皮内和基质内。半桥粒将角膜上皮细胞锚定在羊膜上，密度高达每100微米细胞膜长度165.3±22.9个。可检测到厚度为17.2±4.9纳米的不连续基底膜段。在恢复的角膜上皮细胞之间发现桥粒，密度为每10微米细胞膜长度21.2±5.3个。
羊膜基质可整合到宿主角膜组织中。整合与半桥粒和桥粒等黏附结构的形成有关，这些结构为再生的角膜上皮提供锚定和稳定性。整合的羊膜及与宿主角膜组织的黏附结构的存在支持了AMT在眼表疾病中的临床经验。
