Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Am J Ophthalmol. 2021 Feb;222:292-301. doi: 10.1016/j.ajo.2020.09.030. Epub 2020 Sep 21.
We sought to assess the correlation of corneal endothelial cell (CEC) density to alterations of collagen composition of Descemet membrane (DM) in advanced Fuchs endothelial corneal dystrophy (FECD) and to image such changes by slit-lamp biomicroscopy in vivo.
Prospective, observational consecutive case series.
Fifty eyes (50 subjects) with advanced FECD were enrolled. After slit-lamp biomicroscopy and corneal Scheimpflug imaging, the Descemet endothelium complex (DEC) was retrieved during DM endothelial keratoplasty (DMEK) surgery. The expression of collagens I, III, and IV (COL I, COL III, and COL IV) and corresponding CEC density were analyzed by immunofluorescence flat mount-staining. Presence, diameter and surface area of collagen expression, and CEC density served as the main outcome measures.
Immunofluorescence staining revealed central coherent collagen positive areas (mean surface area = 10 mm ± 6 mm) corresponding to a fibrillar layer burying the guttae of DM in 84% (42/50) of DECs. CEC density overlying the fibrillar layer compared with the periphery was significantly reduced (-54.8%, P < .0001) with a steep decline of CEC density at its borders. Subgroup analysis revealed that the fibrillar layer may be imaged by slit-lamp biomicroscopy in vivo with significant positive correlation of mean maximum diameter detected by slit-lamp biomicroscopy (d = 4.1 mm ± 0.9 mm) and by immunofluorescence staining (d = 4.7 mm ± 1.1 mm; r = 0.76; P = .001).
A fibrillar layer with a clear geographic pattern marks areas of pronounced loss of CEC density in advanced FECD eyes and may be imaged by slit-lamp biomicroscopy in vivo.
我们旨在评估角膜内皮细胞（CEC）密度与晚期 Fuchs 内皮角膜营养不良（FECD）中 Descemet 膜（DM）胶原成分变化的相关性，并通过活体裂隙灯生物显微镜观察这些变化。
前瞻性、观察性连续病例系列。
纳入 50 只眼（50 例）的晚期 FECD 患者。在裂隙灯生物显微镜和角膜 Scheimpflug 成像后，在 DM 内皮角膜移植（DMEK）手术中获取 Descemet 内皮层复合体（DEC）。通过免疫荧光平贴染色分析胶原蛋白 I、III 和 IV（COL I、COL III 和 COL IV）的表达和相应的 CEC 密度。存在、直径和表面面积的胶原蛋白表达和 CEC 密度作为主要观察指标。
免疫荧光染色显示，在 84%（42/50）的 DEC 中，存在中央连续胶原阳性区域（平均表面积为 10mm±6mm），对应 DM 基质中的纤维层埋藏在基质内。与周围相比，纤维层上的 CEC 密度明显降低（-54.8%，P<0.0001），CEC 密度在边界处急剧下降。亚组分析表明，纤维层可能通过活体裂隙灯生物显微镜成像，活体裂隙灯生物显微镜检测到的平均最大直径（d=4.1mm±0.9mm）与免疫荧光染色检测到的直径（d=4.7mm±1.1mm）有显著的正相关（r=0.76，P=0.001）。
晚期 FECD 眼中存在具有明显地理模式的纤维层，标志着 CEC 密度明显丧失的区域，可能通过活体裂隙灯生物显微镜成像。
Zotero 插件