Morphological features of the cornea in eyes with pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy

Close metadata

PURPOSE

To evaluate the morphological features of posterior corneal layers in pseudophakic bullous keratopathy (PBK) and Fuchs endothelial corneal dystrophy (FECD).

MATERIAL AND METHOD

The study included 20 patients (20 eyes) aged 73.8±7.8 with PBK and 24 patients (25 eyes) aged 72.5±10.6 with FECD. Central corneal thickness was measured in all eyes before the surgery by anterior segment optical coherence tomography (AS-OCT, RTVue-100, Optovue, USA). All patients underwent corneal transplantation (DSAEK or DMEK). Postoperative donor graft status was assessed as attached or detached by AS-OCT (RTVue-100, Optovue, USA). Specimens of Descemet’s membranes (DMs) were obtained intraoperatively and investigated histologically (hematoxylin and eosin staining). Morphometric analysis was performed using optical microscope Leica DM-2500 (Digital Color Camera Leica DFC295) and ImageScope M software.

RESULTS

There was no difference in thickness of DMs’ prenatal anterior banded layer (2.58±0.49 μm) and postnatal posterior non-banded layer (11.30±2.64 μm) between PBK and normal cornea. In FECD eyes, DM was significantly thickened by additional collagen layer and guttate excrescences (postnatal layer thickness — 16.62±4.34 μm). Morphological study of the DMs of patients with graft detachment in the early postoperative period revealed residual stromal collagen fibrils that were fixed to the area with dense extracellular matrix.

CONCLUSION

The study shows that chronic corneal edema is associated with pathological morphological changes in the posterior corneal layers in PBK and FECD. Individual features of the dense extracellular matrix in the DMs may play a key role in the attachment of donor graft to the corneal stroma and affect the postoperative outcome.

Keywords:

pseudophakic bullous keratopathy

Fuchs endothelial corneal dystrophy

Descemet’s membrane

DMEK

DSAEK

endothelial graft

morphometric analysis

Authors:

Fisenko N.V.

Krasnov Research Institute of Eye Diseases

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

Trufanov S.V.

Research Institute of Eye Diseases

SPIN RSCI: 1603-8931
Scopus AuthorID: 6508163770
ORCID: 0000-0003-4360-793X

Demura T.A.

Sechenov First Moscow State Medical University

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

Received:

28.12.2020

Accepted:

02.06.2021

List of references:

Bonanno JA. Molecular mechanisms underlying the corneal endothelial pump. Exp Eye Res. 2012;95(1):2-7. https://doi.org/10.1016/j.exer.2011.06.004
Borderie VM, Baudrimont M, Vallée A, Ereau TL, Gray F, Laroche L. Corneal endothelial cell apoptosis in patients with Fuchs’ dystrophy. Invest Ophthalmol Vis Sci. 2000;41(9):2501-2505.
Narayanan R, Gaster RN, Kenney MC. Pseudophakic corneal edema: A review of mechanisms and treatments. Cornea. 2006;25(9):993-1004. https://doi.org/10.1097/01.ico.0000214225.98366.83
Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. Am J Ophthalmol. 2005;139(6):1035-1041. https://doi.org/10.1016/j.ajo.2004.12.080
Ang M, Sng CC, Chee SP, Tan DT, Mehta JS. Outcomes of corneal transplantation for irreversible corneal decompensation secondary to corneal endotheliitis in Asian eyes. Am J Ophthalmol. 2013;156(2):260-266.e2. https://doi.org/10.1016/j.ajo.2013.03.020
Cho SW, Kim JM, Choi CY, Park KH. Changes in corneal endothelial cell density in patients with normal-tension glaucoma. Jpn J Ophthalmol. 2009; 53(6):569-573. https://doi.org/10.1007/s10384-009-0740-1
Yu Z, Wu L, Qu B. Changes in corneal endothelial cell density in patients with primary open-angle glaucoma. World J Clin Cases. 2019;7(15):1978-1985. https://doi.org/10.12998/wjcc.v7.i15.1978
Ayaki M, Yaguchi S, Iwasawa A, Koide R. Cytotoxicity of ophthalmic solutions with and without preservatives to human corneal endothelial cells, epithelial cells and conjunctival epithelial cells. Clin Exp Ophthalmol. 2008; 36(6):553-559. https://doi.org/10.1111/j.1442-9071.2008.01803.x
Subbot AM, Fisenko NV, Trufanov SV. Cytotoxicity of Trusopt and Dorzolan Solo drugs to primary culture of human corneal endothelial cells. Eksperimentalnaya i klinicheskaya farmakologiya. 2020;83(7):27-31. (In Russ.). https://doi.org/10.30906/0869-2092-2020-83-7-27-31
Iliff BW, Riazuddin SA, Gottsch JD. The genetics of Fuchs’ corneal dystrophy. Expert Rev Ophthalmol. 2012;7(4):363-375. https://doi.org/10.1586/eop.12.39
Lee JG, Ko MK, Kay EP. Endothelial mesenchymal transformation mediated by IL-1β-induced FGF-2 in corneal endothelial cells. Exp Eye Res. 2012;95(1):35-39. https://doi.org/10.1016/j.exer.2011.08.003
Yuen HK, Rassier CE, Jardeleza MS, et al. A morphologic study of Fuchs dystrophy and bullous keratopathy. Cornea. 2005;24(3):319-327. https://doi.org/10.1097/01.ico.0000148288.53323.b2
Eghrari AO, Gottsch JD. Fuchs’ corneal dystrophy. Expert Rev Ophthalmol. 2010;5(2):147-159. https://doi.org/10.1586/eop.10.8
Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25(8):987-990. https://doi.org/10.1097/01.ico.0000248385.16896.34
Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25(8):886-889. https://doi.org/10.1097/01.ico.0000214224.90743.01
Malugin BE, Shilova NF, Anisimova NS, Antonova OP. Transplantation of endothelium and Descemet’s membrane. Vestnik oftal’mologii = The Russian Annals of Ophthalmology. 2019;135(1):98-103. (In Russ.). https://doi.org/10.17116/oftalma201913501198
Marques RE, Guerra PS, Sousa DC, et al. Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis. Cornea. 2018;37(6):691-697. https://doi.org/10.1097/ICO.0000000000001581
Brockmann T, Brockmann C, Maier AK, et al. Clinicopathology of graft detachment after Descemet’s membrane endothelial keratoplasty. Acta Ophthalmol. 2014;92(7):556-561. https://doi.org/10.1111/aos.12419
Zhang Q, Randleman JB, Stulting RD, et al. Clinicopathologic findings in failed descemet stripping automated endothelial keratoplasty. Arch Ophthalmol. 2010;128(8):973-980. https://doi.org/10.1001/archophthalmol.2010.140
Gordon SR. Fibronectin antibody labels corneal stromal collagen fibrils in situ along their length and circumference and demonstrates distinct staining along the cell and stromal interfaces of Descemet’s membrane. Curr Eye Res. 2014;39(3):312-316. https://doi.org/10.3109/02713683.2013.841260
Schlötzer-Schrehardt U, Bachmann BO, Laaser K, Cursiefen C, Kruse FE. Characterization of the cleavage plane in Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2011;118(10):1950-1957. https://doi.org/10.1016/j.ophtha.2011.03.025
de Oliveira RC, Wilson SE. Descemet’s membrane development, structure, function and regeneration. Exp Eye Res. 2020;197:108090. https://doi.org/10.1016/j.exer.2020.108090
Johnson DH, Bourne WM, Campbell RJ. The ultrastructure of Descemet’s membrane. I. Changes with age in normal corneas. Arch Ophthalmol. 1982; 100(12):1942-1947. https://doi.org/10.1001/archopht.1982.01030040922011
Murphy C, Alvarado J, Juster R. Prenatal and postnatal growth of the human Descemet’s membrane. Invest Ophthalmol Vis Sci. 1984;25(12):1402-1415.
Kayes J, Holmberg A: The fine structure of the cornea in Fuchs’ endothelial dystrophy. Invest Ophthalmol Vis Sci. 1964;3:47-67.
Bourne WM, Johnson DH, Campbell RJ. The ultrastructure of Descemet’s membrane. III. Fuchs’ dystrophy. Arch Ophthalmol. 1982;100(12):1952-1955. https://doi.org/10.1001/archopht.1982.01030040932013

Close metadata