人工角膜表面组织增生的临床病理分析

目的 探讨人工角膜植入术后表面组织增生(STP)的临床和病理特点,以及其形成原因和防治方法.方法 回顾性病例研究.选择2000年1月至2009年12月间在解放军总医院接受人工角膜植入手术的患者85例(85只眼),男性72例,女性13例,平均年龄为(45±15)岁.术前诊断包括眼烧伤(56只眼)、自身免疫性干眼终末期(14只眼)、眼爆炸伤(10只眼)和重复移植失败(5只眼),对术后STP进行临床观察和治疗.以正常眼前节标本作为对照,对手术切除的增生膜进行病理和免疫组织化学分析.应用Pearson卡方检验比较不同病因患者人工角膜STP阳性率的差异.结果 22例(26%)患者在二期术后出现STP,发生组织增生的中位数时间为7个月(2～63个月).不同病因患者STP的阳性率依次为眼烧伤34%(19/56)、自身免疫性干眼终末期14%(2/14)、爆炸伤10%(1/10)、重复移植失败患者未见组织增生,各组间比较差异无统计学意义(x2=5.93,P=0.11).22例患者中,11例表现为上皮增生,于裂隙灯显微镜下去除增生的上皮,适当调高镜柱后增生被抑制;4例接受了超高频眼表成形手术;7例由于增生膜较厚,在手术显微镜下进行了切除.组织学上,增生膜由上皮细胞和纤维血管组织组成,伴间质慢性炎症反应.免疫组织化学显示,与正常角膜和结膜相比,增生膜上皮层中增殖细胞核抗原表达增多、增强,间质组织中可见大量波形蛋白表达阳性的成纤维细胞和一些α平滑肌肌动蛋白表达阳性的肌纤维母细胞,基质中散在CD45RO阳性的T淋巴细胞,还可见灶状分布的CDllc阳性的树突状细胞和CD68阳性的巨噬细胞.结论 人工角膜镜柱周围组织增牛会导致人工角膜前膜形成,材料-组织交界处过度的炎症反应以及不适当的镜柱高度是引起组织增生的主要原因.

Abstract：

Objective To investigate the clinical and histopathologic features of the superficial tissue proliferation ( STP) following the implantation of MICOF keratoprosthesis, and to analyze the formation and treatment of STP. Methods Retrospective study. Eighty-five patients ( 85 eyes) received MICOF keratoprosthesis surgery from January 2000 through December 2009 in Genera) Hospital of PLA, which included 72 males and 13 females. The mean age of the patients was (45 ±15) years. Preoperative diagnoses were ocular burn (56 eyes) , end-stage of autoimmune dry eye ( 14 eyes) , severe ocular trauma (10 eyes) and repeated graft failure (5 eyes). Postoperatively, STPs of Kpro were observed and treated. The membranes anterior to the optical cylinder were removed and investigated by histological and immunohistochemical methods, and anterior segment specimens from normal eyes were taken as control. Results Twenty-two (26% ) patients presented STP during the follow-up, and proliferations occurred ranging from 2 to 63 months (median, 7 months). The incident rates of STP were 34% (19/56 eyes) in burned eyes,14% (2/14 eyes)in end-stage dry eye, 10% (1/10 eyes)in severe mechanical ocular trauma, and none in repeated grafts failure. Difference among four groups did not arrive significance statistically (x2 =5. 93, P = 0. 11). The epithelial proliferations were observed in 11 patients, which were removed easily. To prevent from recurrence, the height of the cylinder was adjusted. Other 4 patients underwent ultra-high frequency ocular surface plastic operation and 7 patients received membranectomy. Histologically, the superficial proliferative membrane was composed of proliferative epithelium and fibrovascular tissue incorporating inflammatory cells. The immunohistochemical staining demonstrated the expression of PCNA increased in the epithelium, compared with control cornea and conjunctiva. Many vimentin-positive fibroblasts and a few α-SMA-positive myofibroblasts presented in the interstitial tissue, and the numbers of CD45RO-positive T cells, CD11c-positive dendritic cells, and CD68-positive macrophages were increased in proliferative membranes. Conclusions The tissue proliferation around optical cylinder results in membrane formation anterior to the Kpro. The excessive inflammation at the prosthesis-corneal junction and the unsuited height of the optical cylinder might have been the main reasons of STP.

Clinical and histopathologic analysis of superficial tissue proliferation following the implantation of keratoprosthesis

Objective To investigate the clinical and histopathologic features of the superficial tissue proliferation ( STP) following the implantation of MICOF keratoprosthesis, and to analyze the formation and treatment of STP. Methods Retrospective study. Eighty-five patients ( 85 eyes) received MICOF keratoprosthesis surgery from January 2000 through December 2009 in Genera) Hospital of PLA, which included 72 males and 13 females. The mean age of the patients was (45 ±15) years. Preoperative diagnoses were ocular burn (56 eyes) , end-stage of autoimmune dry eye ( 14 eyes) , severe ocular trauma (10 eyes) and repeated graft failure (5 eyes). Postoperatively, STPs of Kpro were observed and treated. The membranes anterior to the optical cylinder were removed and investigated by histological and immunohistochemical methods, and anterior segment specimens from normal eyes were taken as control. Results Twenty-two (26% ) patients presented STP during the follow-up, and proliferations occurred ranging from 2 to 63 months (median, 7 months). The incident rates of STP were 34% (19/56 eyes) in burned eyes,14% (2/14 eyes)in end-stage dry eye, 10% (1/10 eyes)in severe mechanical ocular trauma, and none in repeated grafts failure. Difference among four groups did not arrive significance statistically (x2 =5. 93, P = 0. 11). The epithelial proliferations were observed in 11 patients, which were removed easily. To prevent from recurrence, the height of the cylinder was adjusted. Other 4 patients underwent ultra-high frequency ocular surface plastic operation and 7 patients received membranectomy. Histologically, the superficial proliferative membrane was composed of proliferative epithelium and fibrovascular tissue incorporating inflammatory cells. The immunohistochemical staining demonstrated the expression of PCNA increased in the epithelium, compared with control cornea and conjunctiva. Many vimentin-positive fibroblasts and a few α-SMA-positive myofibroblasts presented in the interstitial tissue, and the numbers of CD45RO-positive T cells, CD11c-positive dendritic cells, and CD68-positive macrophages were increased in proliferative membranes. Conclusions The tissue proliferation around optical cylinder results in membrane formation anterior to the Kpro. The excessive inflammation at the prosthesis-corneal junction and the unsuited height of the optical cylinder might have been the main reasons of STP.