Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany.
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
Cont Lens Anterior Eye. 2024 Jun;47(3):102145. doi: 10.1016/j.clae.2024.102145. Epub 2024 Mar 11.
To report a case of ulcerative keratopathy following implantation of acellular porcine corneal stroma (APCS) in a patient with keratoconus (KC).
A 58 year-old patient initially presented with an ulcerative keratopathy in the left eye. Previously, several corneal procedures (including radial keratotomy, laser-in-situ keratomileusis, crosslinking) were performed for KC. Eight months ago, an APCS lenticule (Xenia corneal implant, Gebauer Medizintechnik GmbH, Neuhausen, Germany) was implanted into a stromal pocket because of progressive keratectasia. Visual acuity was hand movement. Anterior segment optical coherence tomography showed a space between the APCS lenticule and the host stroma. Excimer laser-assisted penetrating keratoplasty (PKP, 8.0/8.1 mm) was performed in the left eye. The corneal explant was investigated by light and transmission electron microscopy.
Best-corrected visual acuity was 20/40 six weeks after PKP. Light microscopy demonstrated a stromal ulceration down to the APCS lenticule. No stromal cells could be found within the APCS lenticule eight months after implantation. The APCS lenticule did not show a green stain of the collagens with Masson-Goldner staining and exhibited a strong Periodic acid-Schiff positive reaction. Electron microscopy of the APCS lenticule revealed cross-linked collagen lamellae without cellular components. Close to the interface, corneal collagen lamellae of the host cornea were disorganized. Few vital keratocytes were present on the surface of the lenticule and appeared to cause mechanical disruption of the host stroma along the lenticule-stroma interface.
APCS implantation may lead to severe complications such as ulcerative keratopathy in otherwise uncomplicated KC corneas. In such cases, excimer laser-assisted PKP or Deep Anterior Lamellar Keratoplasty are the methods of choice to restore visual acuity.
报告一例在圆锥角膜（KC）患者中植入脱细胞猪角膜基质（APCS）后发生溃疡性角膜炎的病例。
一名 58 岁患者最初左眼出现溃疡性角膜炎。此前，该患者因 KC 已接受了多次角膜手术（包括放射状角膜切开术、准分子激光原位角膜磨镶术、交联术）。8 个月前，由于进行性角膜扩张，在基质囊中植入了一片 APCS 透镜（德国 Gebauer Medizintechnik GmbH 公司的 Xenial 角膜植入物）。视力手动。眼前节光学相干断层扫描显示 APCS 透镜与宿主基质之间有空隙。左眼行准分子激光辅助穿透性角膜移植术（PKP，8.0/8.1mm）。对角膜植片进行了光镜和透射电镜检查。
PKP 后 6 周最佳矫正视力为 20/40。光镜显示基质溃疡达 APCS 透镜。植入后 8 个月，在 APCS 透镜内未发现基质细胞。Masson-Goldner 染色未见 APCS 透镜胶原呈绿色染色，过碘酸-Schiff 阳性反应强烈。APCS 透镜的电子显微镜显示交联的胶原板层，无细胞成分。在靠近界面处，宿主角膜的胶原板层排列紊乱。透镜表面仅有少量存活的角膜细胞，似乎沿透镜-基质界面对宿主基质造成机械性破坏。
APCS 植入物可能导致严重并发症，如原本无并发症的 KC 角膜发生溃疡性角膜炎。在这种情况下，准分子激光辅助 PKP 或深层前板层角膜移植术是恢复视力的首选方法。
