根据地形图测量结果和圆锥角膜严重程度，对接受穿透性角膜移植术的圆锥角膜进行组织病理学检查。
Histopathologic findings of keratoconus corneas underwent penetrating keratoplasty according to topographic measurements and keratoconus severity.
作者信息
Naderan Mohammad, Jahanrad Ali, Balali Siavash
机构信息
School of Medicine, Tehran University of Medical Sciences, Tehran 1417653761, Iran.
School of Medicine, AJA University of Medical Sciences, Tehran 1411718541, Iran.
出版信息
Int J Ophthalmol. 2017 Nov 18;10(11):1640-1646. doi: 10.18240/ijo.2017.11.02. eCollection 2017.
AIM
To investigate the histopathologic and morphological changes of the corneas with keratoconus (KC) undergoing penetrating keratoplasty (PKP) according to topographic findings and severity of KC.
METHODS
The corneal tissue of 35 samples with KC was retrospectively evaluated with conventional light microscopy. Topographic and pachymetric parameters of keratoconus corneas by means of Pentacam such as mean keratometry (K) and central corneal thickness (CCT) were recorded. Severity of KC was graded according to Amsler-Krumeich classification.
RESULTS
Epithelial thinning and breaks in Bowman's layer are the most common findings in keratoconus corneas (94.3% and 82.9% corneas, respectively). The results revealed statistically significant higher mean K value and lower CCT in the keratoconus corneas that were affected by epithelial thinning, breaks in the Bowman's layer, folds in the Descemet's membrane, epithelial scars, breaks in Descemet's membrane, and stromal scars than those corneas without these findings (<0.05). Moreover, those corneas with epithelial thinning, breaks in the Bowman's layer, folds in Descemet's membrane, epithelial scars, and stromal scars had significantly more severe disease than those corneas without these findings (<0.05). The presence of the stromal and epithelial scars were associated with the higher KC severity, in which, respectively, 87.5% and 80.0% of the corneas with stromal and epithelial scars had stage 4 of the KC severity.
CONCLUSION
It seems that there are some specific patterns in histologic changes of the keratoconus corneas. The presence of pathologic findings was correlated with thinner and steeper corneas. Epithelial or stromal scars were associated with the highest disease severity. The description of histopathologic findings of KC may help in elucidating the pathogenesis of the disease and help pathologist in differentiating KC from other corneal diseases.
目的
根据圆锥角膜（KC）的地形图表现和严重程度，研究接受穿透性角膜移植术（PKP）的圆锥角膜的组织病理学和形态学变化。
方法
采用传统光学显微镜对35例圆锥角膜样本的角膜组织进行回顾性评估。通过Pentacam记录圆锥角膜的地形图和测厚参数，如平均角膜曲率（K）和中央角膜厚度（CCT）。根据Amsler-Krumeich分类法对圆锥角膜的严重程度进行分级。
结果
上皮变薄和Bowman层破裂是圆锥角膜最常见的表现（分别为94.3%和82.9%的角膜）。结果显示，与无这些表现的角膜相比，受上皮变薄、Bowman层破裂、Descemet膜褶皱、上皮瘢痕、Descemet膜破裂和基质瘢痕影响的圆锥角膜的平均K值在统计学上显著更高，CCT更低（<0.05）。此外，有上皮变薄、Bowman层破裂、Descemet膜褶皱、上皮瘢痕和基质瘢痕的角膜比无这些表现的角膜疾病严重得多（<0.05）。基质和上皮瘢痕的存在与更高的圆锥角膜严重程度相关，其中分别有87.5%和80.0%有基质和上皮瘢痕的角膜处于圆锥角膜严重程度的4期。
结论
圆锥角膜的组织学变化似乎存在一些特定模式。病理表现的存在与更薄、更陡的角膜相关。上皮或基质瘢痕与最高的疾病严重程度相关。对圆锥角膜组织病理学表现的描述可能有助于阐明该疾病的发病机制，并帮助病理学家将圆锥角膜与其他角膜疾病区分开来。
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