Annadanam Anvesh, Stoeger Christopher G, Galloway Joshua D, Hikes Matthew T, Jun Albert S
Cornea, Cataract, and External Disease Division, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Lions VisionGift, Portland, OR.
Cornea. 2019 Jun;38(6):754-757. doi: 10.1097/ICO.0000000000001908.
Previous work has suggested that Descemet membrane (DM) folds arise in response to corneal swelling. However, their origin has not been closely explored. In this study, we used optical coherence tomography to evaluate whether DM folds arise secondary to folds in the middle stroma.
Serial optical coherence tomography images of donor cornea pairs in deionized water were taken for each of the following corneal manipulations: 1) untreated, 2) DM and the endothelium removed, 3) excised in the region of the deep middle/posterior stroma, and 4) excised in the middle stroma.
For intact corneas, increasing duration in deionized water was marked by a progressive increase in corneal thickness and number of folds along the posterior surface. With DM and the endothelium removed, a similar phenomenon was observed. In the third set of corneas, the plane of resection created a structural separation in the region of the deep middle/posterior stroma. Folds were seen originating anterior to the resection plane. For corneas with the posterior and part of the middle stroma removed, the typical folds on the posterior surface as seen in the previous conditions were not observed. Instead, less numerous and smaller irregularities of the posterior surface of the resection plane were present.
Folds in DM associated with corneal edema originate in the middle and posterior stroma and are secondarily transmitted into DM. On the basis of the stromal origin of these anatomic changes, "stromal folds" should be considered a more accurate term to replace "Descemet membrane folds."
先前的研究表明，后弹力层（DM）褶皱是角膜肿胀的反应。然而，其起源尚未得到深入研究。在本研究中，我们使用光学相干断层扫描来评估DM褶皱是否继发于基质中层的褶皱。
对供体角膜对在去离子水中进行以下角膜操作后，拍摄系列光学相干断层扫描图像：1）未处理；2）去除DM和内皮；3）在基质深层/后层区域切除；4）在基质中层切除。
对于完整的角膜，在去离子水中浸泡时间增加的特征是角膜厚度逐渐增加以及后表面褶皱数量增加。去除DM和内皮后，观察到类似现象。在第三组角膜中，切除平面在基质深层/后层区域造成了结构分离。在切除平面之前可见褶皱。对于去除了后层和部分中层基质的角膜，未观察到先前情况下后表面典型的褶皱。相反，切除平面后表面出现的不规则现象较少且较小。
与角膜水肿相关的DM褶皱起源于基质中层和后层，并继发传递至DM。基于这些解剖学变化的基质起源，“基质褶皱”应被视为更准确的术语来取代“后弹力层褶皱”。
