Corneal changes in Fuchs endothelial corneal dystrophy and bullous keratopathy

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OBJECTIVE

Evaluation of structural and immunohistochemical features of cornea in Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK).

MATERIAL AND METHODS

Group 1 — 44 patients (46 eyes) with FECD, group 2 — 42 patients (42 eyes) with BK. All patients underwent keratoplasty. Preoperative anterior segment optical coherence tomography (AS-OCT, RTVue-100, Optovue, USA) was performed. Endothelium—Descemet membrane (EDM) complexes, corneal buttons were obtained intraoperatively. Morphological (H&E staining) and immunohistochemical (primary antibodies to pancytokeratin, vimentin, fibronectin) studies were performed at the light microscope level (Leica DM-2500, Leica Application Suite V4.8, Leica Microsystems, Switzerland).

RESULTS

A direct correlation is found between the results of DM analysis in vivo with OCT and ex vivo with light microscopy. DM thickness (AS-OCT) was significantly greater in FECD (23.0 [19.0; 27.0] μm), than in BK (13.0 [12.0; 14.0] μm). Morphological study of EDM and corneal buttons showed similar difference in DM thickness: 17.9 [16.1; 20.0] μm in FECD and 11.9 [11.3; 13.0] μm in BK. Irregular optical density of stroma is a feature of edema and local fibrosis. In FECD and BK pancytokeratin is expressed in epithelial and endothelial cells, vimentin — in keratocytes, macrophages and vascular endothelium, fibronectin — in DM. In FECD, vimentin is expressed in endothelial cells.

CONCLUSION

FECD and BK are associated with different DM’ and endothelium’ abnormalities, which lead to similar changes of stroma and epithelium. AS-OCT is a useful method of FECD and BK in vivo diagnostics and the selection of treatment option.

Keywords:

Fuchs endothelial corneal dystrophy

bullous keratopathy

optical coherence tomography

Authors:

Demura T.A.

Sechenov First Moscow State Medical University

SPIN RSCI: 2198-5765
Scopus AuthorID: 25936132400
ORCID: 0000-0002-6946-6146

Fisenko N.V.

M.M. Krasnov Research Institute of Eye Diseases

SPIN RSCI: 9750-1529
Scopus AuthorID: 57192992418
ORCID: 0000-0001-7198-4498

Osipyan G.A.

M.M. Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-1056-4331

Afonina M.A.

I.M. Sechenov First Moscow State Medical University

ORCID: 0000-0001-8473-3161

Received:

14.04.2023

Accepted:

21.06.2023

List of references:

Feizi S. Corneal endothelial cell dysfunction: etiologies and management. Ther Adv Ophthalmol. 2018;10:2515841418815802. https://doi.org/10.1177/2515841418815802
Price MO, Mehta JS, Jurkunas UV, Price FW Jr. Corneal endothelial dysfunction: evolving understanding and treatment options. Prog Retin Eye Res. 2021;82:100904. https://doi.org/10.1016/j.preteyeres.2020.100904
Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha Dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res. 2018;66:132-156. https://doi.org/10.1016/j.preteyeres.2018.04.002
Gupta N, Varshney A, Ramappa M, Basu S, Romano V, Acharya M, Gaur A, Kapur N, Singh A, Shah G, et al. Role of AS-OCT in managing corneal disorders. Diagnostics (Basel). 2022;12(4):918. https://doi.org/10.3390/diagnostics12040918
Azarcon CP, Wells JR, Grossniklaus HE. Multimodal imaging and histopathology features of a corneal keloid. Ophthalmology. 2022;129(4):378. https://doi.org/10.1016/j.ophtha.2021.09.017
Shousha MA, Perez VL, Wang J, Ide T, Jiao S, Chen Q, Chang V, Buchser N, Dubovy SR, Feuer W, et al. Use of ultra-high-resolution optical coherence tomography to detect in vivo characteristics of Descemet’s membrane in Fuchs’ dystrophy. Ophthalmology. 2010;117(6):1220-1227. https://doi.org/10.1016/j.ophtha.2009.10.027
Vajzovic LM, Karp CL, Haft P, Shousha MA, Dubovy SR, Hurmeric V, Yoo SH, Wang J. Ultra high-resolution anterior segment optical coherence tomography in the evaluation of anterior corneal dystrophies and degenerations. Ophthalmology. 2011;118(7):1291-1296. https://doi.org/10.1016/j.ophtha.2010.12.015
Brockmann T, Brockmann C, Maier AB, Schroeter J, Bertelmann E, Torun N. Primary Descemet’s membrane endothelial keratoplasty for Fuchs endothelial dystrophy versus bullous keratopathy: histopathology and clinical results. Curr Eye Res. 2018;43(10):1221-1227. https://doi.org/10.1080/02713683.2018.1490773
Sridhar MS. Anatomy of cornea and ocular surface. Indian J Ophthalmol. 2018;66(2):190-194. https://doi.org/10.4103/ijo.IJO_646_17
Kasparova EuA, Subbot AM, Kalinina DB. Proliferative potential of human corneal endothelium. Vestnik Oftal’mologii. 2013; 129(3):82-88. (In Russ.).
Hidayat AA, Cockerham GC. Epithelial metaplasia of the corneal endothelium in Fuchs endothelial dystrophy. Cornea. 2006;25(8): 956-959. https://doi.org/10.1097/01.ico.0000228786.84581.ee
Okumura N, Minamiyama R, Ho LT, Kay EP, Kawasaki S, Tourtas T, Schlötzer-Schrehardt U, Kruse FE, Young RD, Quantock AJ, et al. Involvement of ZEB1 and Snail1 in excessive production of extracellular matrix in Fuchs endothelial corneal dystrophy. Lab Invest. 2015;95(11):1291-1304. https://doi.org/10.1038/labinvest.2015.111
Weller JM, Zenkel M, Schlötzer-Schrehardt U, Bachmann BO, Tourtas T, Kruse FE. Extracellular matrix alterations in late-onset Fuchs’ corneal dystrophy. Invest Ophthalmol Vis Sci. 2014;55(6):3700-3708. https://doi.org/10.1167/iovs.14-14154
Kaluzny BJ, Szkulmowska A, Szkulmowski M, Bajraszewski T, Kowalczyk A, Wojtkowski M. Fuchs’ endothelial dystrophy in 830-nm spectral domain optical coherence tomography. Ophthalmic Surg Lasers Imaging. 2009;40(2):198-200. https://doi.org/10.3928/15428877-20090301-11
De Roo AK, Janssens T, Foets B, van den Oord JJ. Immunohistochemical profiling of corneas with Fuchs endothelial corneal dystrophy. Cornea. 2017;36(7):866-874. https://doi.org/10.1097/ICO.0000000000001212
Liu T, Xu Y, Sun D, Xie L. Histological evaluation of corneal scar formation in pseudophakic bullous keratopathy. PLoS One. 2012;7(6):e39201. https://doi.org/10.1371/journal.pone.0039201
Ljubimov AV, Burgeson RE, Butkowski RJ, Couchman JR, Wu RR, Ninomiya Y, Sado Y, Maguen E, Nesburn AB, Kenney MC. Extracellular matrix alterations in human corneas with bullous keratopathy. Invest Ophthalmol Vis Sci. 1996;37(6):997-1007.
Morishige N, Sonoda KH. Bullous keratopathy as a progressive disease: evidence from clinical and laboratory imaging studies. Cornea. 2013;32(suppl 1):77-83. https://doi.org/10.1097/ICO.0b013e3182a1bc65
Wertheimer CM, Elhardt C, Wartak A, Luft N, Kassumeh S, Dirisamer M, Siedlecki J, Vounotrypidis E, Priglinger SG, Mayer WJ. Corneal optical density in Fuchs endothelial dystrophy determined by anterior segment optical coherence tomography. Eur J Ophthalmol. 2021;31(4):1771-1778. https://doi.org/10.1177/1120672120944796
Castro-Muñozledo F, Meza-Aguilar DG, Domínguez-Castillo R, Hernández-Zequinely V, Sánchez-Guzmán E. Vimentin as a marker of early differentiating, highly motile corneal epithelial cells. J Cell Physiol. 2017;232(4):818-830. https://doi.org/10.1002/jcp.25487
Thaung C, Davidson AE. Fuchs endothelial corneal dystrophy: current perspectives on diagnostic pathology and genetics-Bowman Club Lecture. BMJ Open Ophthalmol. 2022;7(1):e001103. https://doi.org/10.1136/bmjophth-2022-001103

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