Elder M J, Hiscott P, Dart J K
Moorfields Eye Hospital, London, England.
Hum Pathol. 1997 Dec;28(12):1348-54. doi: 10.1016/s0046-8177(97)90222-7.
Cicatricial conjunctivitis may be a sequel to systemic disorders (eg, Stevens-Johnson syndrome, cicatricial pemphigoid) or local disorders such as chemical burns. The cicatrisation is often associated with corneal epithelial changes that cause visual loss. These have been attributed to encroachment of the conjunctival epithelium over the cornea. However, the epithelial anomalies are poorly understood. We investigated the corneal epithelial changes in cicatricial conjunctivitis with an immunohistochemical study of intermediate filaments in normal and pathological specimens. Our results show that the normal corneal epithelium is immunoreactive for cytokeratin 3 (CK 3) but not cytokeratin 19 (CK 19), whereas normal conjunctival epithelium is CK 3 negative and CK 19 positive. Conjunctiva artificially transposed over the cornea (after therapeutic conjunctival flap reconstruction) retained the normal pattern of conjunctival cytokeratin expression (CK 3 negative, CK 19 positive). Conversely, the entire corneal epithelium exhibited the normal cytokeratin pattern (CK 3 positive, CK 19 negative) in 82% of Stevens-Johnson, 80% of cicatricial pemphigoid, and 69% of chemical burns specimens. The findings suggest that conjunctival encroachment is not responsible for the changes at the corneal surface in cicatricial conjunctivitis and that the abnormal corneal epithelium is derived from native corneal cells in these diseases.
瘢痕性结膜炎可能是全身性疾病（如史蒂文斯-约翰逊综合征、瘢痕性类天疱疮）或局部疾病（如化学烧伤）的后遗症。瘢痕形成通常与导致视力丧失的角膜上皮变化有关。这些变化被认为是结膜上皮向角膜侵犯所致。然而，上皮异常的情况仍知之甚少。我们通过对正常和病理标本中的中间丝进行免疫组织化学研究，调查了瘢痕性结膜炎中的角膜上皮变化。我们的结果显示，正常角膜上皮对细胞角蛋白3（CK 3）呈免疫反应，但对细胞角蛋白19（CK 19）无反应，而正常结膜上皮CK 3阴性、CK 19阳性。人工移植到角膜上的结膜（治疗性结膜瓣重建后）保留了结膜细胞角蛋白表达的正常模式（CK 3阴性、CK 19阳性）。相反，在82%的史蒂文斯-约翰逊综合征标本、80%的瘢痕性类天疱疮标本和69%的化学烧伤标本中，整个角膜上皮呈现出正常的细胞角蛋白模式（CK 3阳性、CK 19阴性）。这些发现表明，结膜侵犯并非瘢痕性结膜炎角膜表面变化的原因，且这些疾病中异常的角膜上皮源自角膜自身细胞。
