Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
Ophthalmology. 2011 Oct;118(10):1950-7. doi: 10.1016/j.ophtha.2011.03.025. Epub 2011 Jun 25.
To define the cleavage plane between Descemet's membrane (DM) and posterior corneal stroma in Descemet's membrane endothelial keratoplasty (DMEK) concerning its ultrastructural and immunohistochemical characteristics.
Observational, consecutive case series.
Fifteen corneoscleral buttons from donors 71.5±4.3 years of age stored in Optisol-GS and used for DMEK surgery in 15 consecutive patients.
Endothelial cell-DM complexes (EDMs) and corresponding corneoscleral rims were investigated by transmission electron microscopy and immunohistochemistry using a panel of antibodies against adhesive matrix proteins.
Ultrastructural and immunohistochemical characteristics of interface and cleavage plane between DM and posterior stroma.
Connection between DM and corneal stroma was mediated predominantly by amorphous material of the interfacial matrix and projecting stromal collagen fibers. After DM stripping, the cleavage plane was located consistently between interfacial matrix and posterior stromal collagen lamellae, providing a largely smooth anterior EDM surface exposing the interfacial zone. Interindividual variations in amount and composition of the interfacial matrix resulted in variable degrees of EDM surface irregularities and variable staining patterns for adhesive matrix proteins such as fibronectin, vitronectin, amyloid P, osteonectin/secreted protein acidic and rich in cysteine (SPARC), fibulin-1, fibulin-2, fibulin-3, fibrillin-1, and keratoepithelin.
The findings provide evidence for the existence of a physiologic cleavage plane between the interfacial matrix, the anteriormost adhesive zone of DM, and the corneal stroma, suggesting a relatively weak attachment that can be disconnected by mechanical forces. Interindividual variations in structure and composition of the interfacial matrix may provide an explanation for the variable attachment of EDM grafts to the recipients' corneal stroma and thus may affect the postoperative clinical outcome.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
根据 Descemet 膜（DM）和后角膜基质在 Descemet 膜内皮角膜移植术（DMEK）中的超微结构和免疫组织化学特征，定义 DM 和后角膜基质之间的分裂平面。
观察性、连续病例系列。
来自年龄为 71.5±4.3 岁的供体的 15 个角膜 - 巩膜瓣，保存在 Optisol-GS 中，并用于 15 名连续患者的 DMEK 手术。
使用针对粘附基质蛋白的抗体组合，通过透射电子显微镜和免疫组织化学研究内皮细胞-DM 复合物（EDM）和相应的角膜 - 巩膜边缘。
DM 和后基质之间界面和分裂平面的超微结构和免疫组织化学特征。
DM 和角膜基质之间的连接主要通过界面基质的无定形物质和突出的基质胶原纤维介导。在 DM 剥离后，分裂平面始终位于界面基质和后基质胶原板层之间，提供了一个大致光滑的前 EDM 表面，暴露了界面区。界面基质的数量和组成的个体间差异导致 EDM 表面不规则的程度不同，并且粘附基质蛋白（如纤维连接蛋白、纤连蛋白、淀粉样蛋白 P、骨桥蛋白/富含半胱氨酸的分泌蛋白酸性和丰富（SPARC）、纤维连接蛋白-1、纤维连接蛋白-2、纤维连接蛋白-3、原纤维蛋白-1 和角蛋白上皮素）的染色模式也不同。
这些发现为界面基质、DM 的最前粘附区和角膜基质之间存在生理分裂平面提供了证据，表明存在相对较弱的附着，可以通过机械力分离。界面基质的结构和组成的个体间差异可能为 EDM 移植物与受者角膜基质的附着程度不同提供了解释，从而可能影响术后临床结果。
作者没有讨论的材料中没有任何专有或商业利益。
