St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
Cornea. 2011 Apr;30(4):460-1. doi: 10.1097/ICO.0b013e3181f23901.
To report a case of subepithelial infiltrates (SEIs) comprising Langerhans cells, 25 months after deep anterior lamellar keratoplasty (DALK) for keratoconus.
A case report based on clinical and confocal microscopic examination.
A 26-year-old man with progressive keratoconus underwent left DALK. Routine follow-up 25 months postoperatively revealed a rust ring in the graft, scattered SEIs in the edematous donor anterior corneal stroma, and keratic precipitates. The graft cleared after removal of the rust ring and treatment with guttae prednisolone 1%. In vivo confocal microscopy showed accumulation of hyperreflective dendritic structures typical of Langerhans cells at the level of the basal epithelium and the Bowman membrane.
DALK is an alternative to penetrating keratoplasty in patients with a healthy endothelium. Stromal rejection has been reported up to 41 months postoperatively after DALK. The SEIs and the stromal edema in this case indicated stromal rejection. Increased concentration of antigen-presenting Langerhans cells found on confocal microscopy of the SEIs point to their involvement in the stromal rejection in DALK cases.
报告 1 例在圆锥角膜行深板层角膜移植术（DALK） 25 个月后出现上皮下浸润（SEIs）的病例，该 SEIs 包含朗格汉斯细胞。
基于临床和共聚焦显微镜检查的病例报告。
1 名 26 岁男性，因进行性圆锥角膜行左眼 DALK。术后 25 个月的常规随访显示移植物出现锈环，水肿的供体角膜前部基质中存在散在 SEIs 和角膜后沉着物。锈环去除和普拉洛芬滴眼液 1%治疗后，移植物得到清除。体内共聚焦显微镜显示在基底上皮和Bowman 膜水平积聚了典型的朗格汉斯细胞的高反射状树突结构。
DALK 是健康内皮患者行穿透性角膜移植术的替代方法。DALK 术后 41 个月内已报道有基质排斥反应。本例中的 SEIs 和基质水肿表明存在基质排斥反应。共聚焦显微镜下 SEIs 中抗原呈递朗格汉斯细胞浓度增加表明它们参与了 DALK 中的基质排斥反应。
