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Garis M, Meyer MD, Lwigale P. Expression of Nephronectin in the Descemet's membrane of mouse corneas during development and adult homeostasis. Exp Eye Res 2024; 240:109797. [PMID: 38246333 DOI: 10.1016/j.exer.2024.109797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
Nephronectin (Npnt) is an extracellular matrix (ECM) protein with pleiotropic functions during organogenesis, disease, and homeostasis. Although the ECM plays a crucial role during development and homeostasis of the adult cornea, little is known about the expression of Npnt in the mammalian cornea. Here, we investigated the expression of Npnt during early embryonic and postnatal development, and in adult mouse corneas. We combined ultrastructural and immunohistochemical analyses to study the early formation of the Descemet's membrane and how the expression of Npnt relates to key basement membrane proteins. Our section in situ hybridization and immunohistochemical analyses revealed that Npnt mRNA is expressed by the nascent corneal endothelial cells at embryonic day (E) 14.5, whereas the protein is localized in the adjacent extracellular matrix. These expression patterns were maintained in the corneal endothelium and Descemet's membrane throughout development and in adult corneas. Ultrastructural analysis revealed discontinuous electron dense regions of protein aggregates at E18.5 that was separated from the endothelial layer by an electron lucent space. At birth (postnatal day, P0), the Descemet's membrane was a single layer, which continuously thickened throughout P4, P8, P10, and P14. Npnt was localized to the Descemet's membrane by E18.5 and overlapped with Collagens IV and VIII, Laminin, and Perlecan. However, the proteins subsequently shifted and formed distinct layers in the adult cornea, whereby Npnt localized between two Collagen VIII bands and anterior to Collagen IV but overlapped with Laminin and Perlecan. Combined, our results reveal the expression of Npnt in the mouse cornea and define its spatiotemporal localization relative to key basement membrane proteins during the formation of the Descemet's membrane and in the adult cornea. Understanding the spatiotemporal expression of Npnt is important for future studies to elucidate its function in the mammalian cornea.
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Affiliation(s)
- Matthew Garis
- Department of Biosciences, Rice University, Houston, TX, 77019, USA
| | - Matthew D Meyer
- Shared Equipment Authority, Rice University, Houston, TX, 77019, USA
| | - Peter Lwigale
- Department of Biosciences, Rice University, Houston, TX, 77019, USA.
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Dua HS, Freitas R, Sadek Y, Ting DSJ, Nubile M, Mohammed I, Said DG. An approach to reduce Descemet's membrane scrolling: Relevance to Descemet's membrane endothelial keratoplasty (DMEK). Indian J Ophthalmol 2023; 71:3178-3185. [PMID: 37602605 PMCID: PMC10565912 DOI: 10.4103/ijo.ijo_1531_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose We aimed to determine whether Descemet's membrane (DM) scrolling occurs primarily along the vertical or horizontal axis and establish whether oval trephination along the axis of least scrolling can reduce the grade of the scroll. Methods The longest limbus-to-limbus axis on 28 sclerocorneal discs was taken as the horizontal axis. The horizontal (n = 7) or (right angles to it) vertical (n = 6) axis was marked on DM before peeling it off. The direction and grade of scrolling was observed. Narrow strips (3-4 mm wide) were then cut along the two axes (n = 4 each) and the scrolling pattern was observed. Ellipses (7 × 9 mm) of DM were punched along the two axes (n = 6 each) and the scrolls graded. Immunofluorescent staining for elastin on horizontal and vertical tissue sections from three DM samples was performed. The intensity and thickness of elastin staining were measured. Results Twenty-four (85.72%) DM samples showed scrolling along the horizontal axis, none showed scrolling along the vertical axis, and four (14.28%) samples showed a spiral scroll, regardless of which axis was marked (grade 3.7 and 3.6). Vertically oval discs showed significantly reduced scrolling (grade 1.2) compared to horizontally oval discs (grade 3.5). Narrow strips of DM showed a similar scrolling pattern. Immunohistology showed no difference in any of the parameters examined along the two axes or from the center to the periphery. Conclusion DM scrolls primarily along the horizontal axis. Vertically oval DM samples show minimal scrolling, which can be an advantage in DMEK. Differential scrolling is not determined by the distribution of elastin.
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Affiliation(s)
- Harminder S Dua
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Rui Freitas
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
- Department of Ophthalmology, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal
| | - Youssef Sadek
- Department of Medicine, University of Birmingham, Birmingham Research Park, Birmingham, UK
| | - Darren SJ Ting
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Mario Nubile
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d’Annunzio of Chieti-Pescara, Italy
| | - Imran Mohammed
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
| | - Dalia G Said
- Department of Ophthalmology, Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, and the Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK
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Albuainain A, Aldofyan MZ, Otaif W, Al-Muammar A, Alsubki H, Alkatan HM. Successful management of a retained host Descemet's membrane after penetrating keratoplasty (PKP) - A case report. Int J Surg Case Rep 2023; 109:108595. [PMID: 37536097 PMCID: PMC10415706 DOI: 10.1016/j.ijscr.2023.108595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE To report the 21st case showing the rare occurrence of retained Descemet's membrane (DM) following penetrating keratoplasty (PKP). We intend to investigate possible etiologies, expected sequelae, and outcome of neodymium-dpoed yttrium alumnium garnet (Nd: YAG) laser membranectomy. CASE PRESENTATION Our case is a 74-year-old male who underwent PKP surgery in the right eye secondary to corneal decompensation following cataract surgery in addition to corneal thinning secondary to superficial keratectomy related to the pre-existing climatic droplet keratopathy (CDK). Postoperative assessment revealed a retro-corneal membrane within the anterior chamber, which was affecting his vision. CLINICAL DISCUSSION Based on the post-operative course and the decreased vision as an indication for intervention, it was decided to excise the retained DM. Membranectomy with Nd: YAG laser was performed, and the patient's visual acuity measurement improved from 20/400 to 20/25. However, the endothelial cell count decreased from 1479 to 520 cells/mm2 (35 % loss) at 15 months post YAG membranectomy with clear graft. Histopathological examination confirmed the clinical suspicion of a retained DM, since it was absent in the submitted host corneal tissue in addition to the pre-existing CDK. CONCLUSION Retention of DM following PKP is a rare but possible complication and high index of suspicion is required for proper diagnosis and management to obtain better visual outcome. Nd: YAG laser membranectomy was effective in excising the retained DM and improving vision. Endothelial cell loss following Nd: YAG laser membranectomy as a complication was observed and should be addressed during the treatment plan.
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Affiliation(s)
- Abdulrahman Albuainain
- Eye and Laser Center, Bahrain Defense Force Hospital, Royal Medical Services, Military Hospital, Riffa, Bahrain
| | - Munirah Z Aldofyan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Otaif
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Al-Muammar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Haneen Alsubki
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Sharma A, Sharma R, Kulshreshta A, Nirankari VS. Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique. Indian J Ophthalmol 2023; 71:2234-2236. [PMID: 37202957 PMCID: PMC10391505 DOI: 10.4103/ijo.ijo_1623_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet's membrane (DM) could be visualized. We performed a novel surgical approach, "double-bubble pneumo-descemetopexy." The surgical procedure included unrolling of DM with "small air bubble" and descemetopexy with "big bubble." No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet's stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.
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Affiliation(s)
- Ashok Sharma
- Director, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Rajan Sharma
- Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Ashish Kulshreshta
- Associate, Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Verinder S Nirankari
- Department of Ophthalmology, University of Maryland, College Park, Maryland, USA
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5
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Petrela RB, Patel SP. The soil and the seed: The relationship between Descemet's membrane and the corneal endothelium. Exp Eye Res 2023; 227:109376. [PMID: 36592681 DOI: 10.1016/j.exer.2022.109376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Descemet's membrane (DM), the basement membrane of the corneal endothelium, is formed from the extracellular matrix (ECM) secreted by corneal endothelial cells. The ECM supports the growth and function of the corneal endothelial cells. Changes to DM are central to the diagnosis of the most common corneal endothelial disease, Fuchs endothelial corneal dystrophy (FECD). Changes in DM are also noted in systemic diseases such as diabetes mellitus. In FECD, the DM progressively accumulates guttae, "drop-like deposits" that disrupt the corneal endothelial cell monolayer. While the pathophysiologic changes to corneal endothelial cells in the course of FECD have been well described and reviewed, the changes to DM have received limited attention. The reciprocity of influence between the corneal endothelial cells and DM demands full attention to the latter in our search for novel treatment and preventive strategies. In this review, we discuss what is known about the formation and composition of DM and how it changes in FECD and other conditions. We review characteristics of guttae and the interplay between corneal endothelial cells and guttae, particularly as it might apply to future cell-based and genetic therapies for FECD.
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Affiliation(s)
- Redion B Petrela
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 1176 Main Street, Buffalo, NY, 14209, USA; Norton College of Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Sangita P Patel
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 1176 Main Street, Buffalo, NY, 14209, USA; Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, 3495 Bailey Ave, Buffalo, NY, 14215, USA.
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Tint NL, Cheng KKW, Dhillon AS, Keane PA, Alexander P, Kennedy D, Chau DYS, Rose FRAJ, Allan BDS. An in vitro assessment of the thermoreversible PLGA-PEG-PLGA copolymer: Implications for Descemet's membrane endothelial keratoplasty. Clin Exp Ophthalmol 2023; 51:58-66. [PMID: 36086942 DOI: 10.1111/ceo.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To explore the use of a thermoreversible copolymer gel coating to prevent donor tissue scrolling in Descemet's membrane endothelial keratoplasty (DMEK). METHODS PLGA-PEG-PLGA triblock copolymer was synthesised via ring opening polymerisation. Two formulations were fabricated and gelation properties characterised using rheological analyses. Endothelial cytotoxicity of the copolymer was assessed using a Trypan Blue exclusion assay. Thickness of the copolymer gel coating on the endothelial surface was analysed using anterior segment optical coherence tomography (OCT) (RTVue-100, Optovue Inc.). Gold nanoparticles were added to the copolymer to aid visualisation using OCT. Prevention of Descemet membrane donor scrolling was represented via a novel, in vitro, immersion of copolymer coated donor graft material. RESULTS Two different formulations of PLGA-PEG-PLGA copolymer were successfully fabricated and the desired peak gelling temperature of 24°C was achieved by polymer blending. Application of 20%, 30% and 40% (wt/vol) polymer concentrations resulted in a statistically significant increase in polymer thickness on the endothelium (p < 0.001). There was no detectable endothelial cytotoxicity. The polymer was easy to apply to the endothelium and prevented scrolling of the DMEK graft. CONCLUSION This PLGA-PEG-PLGA thermoreversible copolymer gel could be exploited as a therapeutic aid for preventing DMEK graft scrolling.
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Affiliation(s)
- Naing L Tint
- Moorfields Eye Hospital NHS Foundation Trust, Cornea and External Eye Disease Service, London, UK.,Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK
| | | | - Amritpaul S Dhillon
- Division of Regenerative Medicine and Cellular Therapies, Nottingham Biodiscovery Institute, School of Pharmacy Nottingham, University of Nottingham, Nottinghamshire, UK
| | - Pearse A Keane
- Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, NIHR Biomedical Research Centre for Ophthalmology, London, London, UK
| | - Philip Alexander
- Division of Regenerative Medicine and Cellular Therapies, Nottingham Biodiscovery Institute, School of Pharmacy Nottingham, University of Nottingham, Nottinghamshire, UK
| | - David Kennedy
- Moorfields Eye Hospital NHS Foundation Trust, Lions Eye Bank, London, UK
| | - David Y S Chau
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London, London, UK
| | - Felicity R A J Rose
- Division of Regenerative Medicine and Cellular Therapies, Nottingham Biodiscovery Institute, School of Pharmacy Nottingham, University of Nottingham, Nottinghamshire, UK
| | - Bruce D S Allan
- Moorfields Eye Hospital NHS Foundation Trust, Cornea and External Eye Disease Service, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, NIHR Biomedical Research Centre for Ophthalmology, London, London, UK
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Gupta S, Mahalingam K, Singh A, Selvan H, Somarajan BI, Gupta V. Posterior corneal morphological changes in primary congenital glaucoma. Indian J Ophthalmol 2022; 70:2571-2577. [PMID: 35791159 PMCID: PMC9426191 DOI: 10.4103/ijo.ijo_317_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To compare posterior corneal morphology between older treated and younger untreated children with primary congenital glaucoma (PCG) using anterior segment optical coherence tomography (ASOCT) and intraoperative OCT (iOCT), respectively. Methods: In this comparative study, ASOCT of older PCG children were compared with iOCT of younger untreated PCG patients. Differences between the two groups with respect to posterior corneal morphology were studied. Results: Observed morphological patterns within posterior cornea in older treated (age: 72–300 months) children (87 eyes) included Descemet’s membrane (DM) excrescences (70%), thickened DM (35%), intracameral twin protuberances (92%), and DM detachment (26%). Changes within pre-Descemet’s layer (PDL) (28%) included thickening, breaks, and detachments. Extent of Haab’s striae was associated with thickness of DM/PDL complex (P = 0.008) when analyzed in the treated group. In contrast, in the untreated group (n = 53 eyes, age 1–63 months), posterior corneal changes were limited to diffuse hyper-reflectivity of the DM/PDL complex, with absence of DM tears. Conclusion: Posterior cornea thickens and Haab’s striae become more circumscribed in eyes of older treated children compared to untreated PCG eyes, probably reflecting a healing response of posterior cornea over time.
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Affiliation(s)
- Shikha Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Karthikeyan Mahalingam
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Singh
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Harathy Selvan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu I Somarajan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Sampaio LP, Shiju TM, Hilgert GSL, de Oliveira RC, DeDreu J, Menko AS, Santhiago MR, Wilson SE. Descemet's membrane injury and regeneration, and posterior corneal fibrosis, in rabbits. Exp Eye Res 2021; 213:108803. [PMID: 34736886 DOI: 10.1016/j.exer.2021.108803] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/26/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023]
Abstract
The purpose of this investigation was to study Descemet's membrane and corneal endothelial regeneration, myofibroblast generation and disappearance, and TGF beta-1 localization after Descemet's membrane-endothelial excision (Descemetorhexis) in rabbits. Thirty-six rabbits had 8 mm Descemetorhexis and standardized slit lamp photos at 1, 2 and 4 days, 1, 2 and 4 weeks, and 2, 4 and 6 months, as well as multiplex IHC for stromal cell markers keratocan, vimentin, and alpha-smooth muscle actin (SMA); basement membrane (BM) components perlecan, nidogen-1, laminin alpha-5, and collagen type IV; and corneal endothelial marker Na,K-ATPase β1, and TGF beta-1, with ImageJ quantitation. Stromal transparency increased from the periphery beginning at two months after injury and progressed into the central cornea by six months. At six months, central transparency was primarily limited by persistent mid-stromal neovascularization. Stromal myofibroblast zone thickness in the posterior stroma peaked at one month after injury, and then progressively decreased until to six months when few myofibroblasts remained. The regeneration of a laminin alpha-5 and nidogen-1 Descemet's membrane "railroad track" structure was accompanied by corneal endothelial closure and stromal cell production of BM components in corneas from four to six months after injury. TGF beta-1 deposition at the posterior corneal surface from the aqueous humor peaked at one day after Descemetorhexis and diminished even before regeneration of the endothelium and Descemet's membrane. This decrease was associated with collagen type IV protein production by corneal fibroblasts, and possibly myofibroblasts, in the posterior stroma. Descemet's membrane and the corneal endothelium regenerated in the rabbit cornea by six months after eight mm Descemetorhexis. Real-time quantitative RT-PCR experiments in vitro with marker-verified rabbit corneal cells found that 5 ng/ml or 10 ng/ml TGF beta-1 upregulated col4a1 or col4a2 mRNA expression after 6 h or 12 h of exposure in corneal fibroblasts, but not in myofibroblasts. Stromal cells produced large amounts of collagen type IV that likely decreased TGF beta-1 penetration into the stroma and facilitated the resolution of myofibroblast-generated fibrosis.
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Affiliation(s)
- Lycia Pedral Sampaio
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Rodrigo Carlos de Oliveira
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | - JodiRae DeDreu
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - A Sue Menko
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Goweida MB, Mahmoud S, Sobhy M, Liu C. Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane Perforation: Should We Stop Conversion to Penetrating Keratoplasty? J Curr Ophthalmol 2021; 33:171-176. [PMID: 34409228 PMCID: PMC8365580 DOI: 10.4103/2452-2325.303199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the outcome of eyes with large Descemet's membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK). Methods A retrospective, interventional case series of 12 eyes with completed DALK, despite DM perforation larger than 4 mm in its widest dimension. The main outcome measures included graft clarity, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and DM detachment. Results The mean age of patients was 26.8 ± 11.4 years. Preoperative pathology included keratoconus (n = 10), macular dystrophy (n = 1), and postmicrobial keratitis corneal scar (n = 1). The average size of DM perforation was 6.5 mm ± 1.3 mm. At the end of the follow-up period (median 15 months, range 6-53 months), the mean CDVA was 0.32 ± 0.09 logMAR and the mean ECD was 1830.8 ± 299.7 cells/mm2. Nine patients (75%) developed DM detachments postoperatively and was managed by intracameral air injection once in six eyes, and twice in three eyes. Other complications included persistent localized stromal edema at the site of DM defect in one eye and Urrets Zavalia syndrome in one eye. Conclusion Completing DALK in eyes with large DM perforation provides good visual acuity, endothelial cell count and may be superior to penetrating keratoplasty regarding long-term graft survival if confirmed in future comparative studies.
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Affiliation(s)
- Mohamed Bahgat Goweida
- Alexandria Main University Hospital, Alexandria, Egypt.,Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Shahira Mahmoud
- Alexandria Main University Hospital, Alexandria, Egypt.,Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sobhy
- Alexandria Main University Hospital, Alexandria, Egypt.,Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Christopher Liu
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.,Tongdean Eye Clinic, Hove, United Kingdom.,Brighton and Sussex Medical School, Brighton, United Kingdom
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10
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Tsai MC, Daniels JT. The impact of biomechanics on corneal endothelium tissue engineering. Exp Eye Res 2021; 209:108690. [PMID: 34216616 DOI: 10.1016/j.exer.2021.108690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
The integrity of innermost layer of the cornea, the corneal endothelium, is key to sustaining corneal transparency. Therefore, disease or injury causing loss or damage to the corneal endothelial cell population may threaten vision. Transplantation of corneal tissue is the standard treatment used to replace malfunctioning corneal endothelial cells. However, this surgery is dependent upon donor tissue, which is limited in supply. Hence, tissue engineers have attempted to construct alternative transplantable tissues or cell therapies to alleviate this problem. Nevertheless, the intrinsic non-dividing nature of corneal endothelial cells continues to foil scientists in their attempts to yield large numbers of cells in the laboratory for use in such novel therapies. Interestingly, the contribution of the biomechanical properties of the underlying extracellular matrix (ECM) on cell division, tissue development and maintenance has been extensively investigated in other many cell types. However, the impact of biomechanics on corneal endothelial cell behaviour is relatively unexplored. Here, we describe contemporary tissue engineering solutions aimed at circumventing donor tissue scarcity. We review the ECM structure and biomechanical features of corneal endothelial cells. We discuss the alterations of ECM in endothelial disease development and progression and point out the role of ECM in developing a tissue-engineered corneal endothelium. We highlight the main biomechanical cues, including topographical and mechanical features, that impact cellular behaviors. Finally, we discuss the influence of biomechanical cues on cell and tissue development, and how corneal endothelial cells response to individual biomechanical stimuli in tissue engineering, which have implications for designing an engineered endothelium and maintaining cell function.
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Affiliation(s)
- Meng-Chen Tsai
- UCL Institute of Ophthalmology, University College London, London, UK.
| | - Julie T Daniels
- UCL Institute of Ophthalmology, University College London, London, UK
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11
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Ashena Z, Nanavaty MA. Re-Endothelialization of Bare Stroma after Descemet's Detachment due to Macroperforation during Deep Anterior Lamellar Keratoplasty. J Curr Ophthalmol 2020; 32:423-426. [PMID: 33553849 PMCID: PMC7861102 DOI: 10.4103/joco.joco_79_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To report a case with spontaneous re-endothelialization of bare stroma after subtotal detachment of Descemet's membrane (DM) due to macroperforation during deep anterior lamellar keratoplasty (DALK). Methods Case report. Results A 64-year-old patient underwent DALK for deep stromal scarring secondary to herpetic keratitis. During manual dissection, DM macroperforation occurred, and this was successfully managed intraoperatively and postoperatively. The DM with host posterior stroma remained attached for 10 months when it detached from the bare donor stroma. The cornea remained clear, with uncorrected distance visual acuity (UCVA) of 0.17 logMAR. After graft suture removal 30 months later, he was noted to have regular astigmatism and cataract for which he underwent phacoemulsification with toric intraocular lens implantation. Twenty-four months following his cataract surgery and 58 months following his DALK, his UCVA remains 0.17 logMAR and the cornea remains clear with no evidence of edema. His average specular count at 58 months was 1296 cell/mm2 . Conclusion This case shows a very good visual outcome with clear cornea at 58 months despite of large DM detachment which happened 10 months following manual DALK with intraoperative macroperforation.
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Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Mayank A Nanavaty
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.,Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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12
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Abstract
Myofibroblasts are alpha-smooth muscle actin (SMA)+ cells that have a critical role in the corneal stromal response to infections, injuries, and surgeries, and which produce corneal scarring fibrosis when they develop in excess. These contractile and opaque cells-produce large amounts of disordered extracellular matrix (ECM)-and develop from keratocyte-derived corneal fibroblasts or bone marrow-derived fibrocytes, and possibly other cell types, in response to TGFβ1, TGFβ2 and PDGF from the epithelium, tears, endothelium, and other stromal cells. Recent proteomic analyses have revealed that the myofibroblasts that develop from different progenitors aren't interchangeable, but have major differences in protein expression and functions. Absence or defective regeneration of the epithelial basement membrane (EBM) and/or Descemet's basement membrane (DBM) results in development and persistence of myofibroblasts in the corneal stroma. The functions of myofibroblasts in the cornea include production of volume-additive ECM, tissue contraction, production of various growth factors, cytokines and chemokines that regulate stromal cells, including other myofibroblasts, production of collagenases and metalloproteinases involved in tissue remodeling, and the expression of toll-like receptors that likely have critical roles in the clearance of bacteria and viruses causing corneal infections.
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13
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An JH, Park SY, Kim GH, Mo IP, Kim S, Woo HM, Park KM. Tissue engineered ultra-thin descemet stripping corneal endothelial layers using porcine cornea and stem cells. Exp Eye Res 2020; 199:108192. [PMID: 32805263 DOI: 10.1016/j.exer.2020.108192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
Due to their very poor proliferative capacity, the dysfunction of corneal endothelial cells can sometimes lead to incurable eye diseases that require corneal transplantation. Although many studies have been performed to reconstruct corneal endothelial cells, corneal transplantation is still considered to be the established approach. In this study, we developed bio-engineered Descemet stripping endothelial (DSE) layers, using porcine cornea and induced pluripotent stem cell (iPSC)-derived corneal endothelial cells (iCECs). First, we optimized a protocol to prepare an ultra-thin and decellularized Descemet stripping (DS) scaffold from porcine cornea. Our DS layers show over 90% transparency compared to the control. Porcine-derived cells and xenogenic antigens disappeared, whereas the collagen matrix remained in the graft. Next, corneal endothelial cell lines or iCECs were seeded on the decellularized DS graft and cultured for 7 days. The drying method reduced graft rolling and edema, and increased transparency during culture. The reseeded cells were evenly distributed over the graft, and most of the cells survived. Although future clinical studies are warranted, engineered DSE tissues using xenogenic tissues and stem cells will be useful tools for the treatment of incurable corneal diseases.
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14
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McKay TB, Schlötzer-Schrehardt U, Pal-Ghosh S, Stepp MA. Integrin: Basement membrane adhesion by corneal epithelial and endothelial cells. Exp Eye Res 2020; 198:108138. [PMID: 32712184 DOI: 10.1016/j.exer.2020.108138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
Integrins mediate adhesion of cells to substrates and maintain tissue integrity by facilitating mechanotransduction between cells, the extracellular matrix, and gene expression in the nucleus. Changes in integrin expression in corneal epithelial cells and corneal endothelial cells impacts their adhesion to the epithelial basement membrane (EpBM) and Descemet's membrane, respectively. Integrins also play roles in assembly of basement membranes by both activating TGFβ1 and other growth factors. Over the past two decades, this knowledge has been translated into methods to grow corneal epithelial and endothelial cells in vitro for transplantation in the clinic thereby transforming clinical practice and quality of life for patients. Current knowledge on the expression and function of the integrins that mediate adhesion to the basement membrane expressed by corneal epithelial and endothelial cells in health and disease is summarized. This is the first review to discuss similarities and differences in the integrins expressed by both cell types.
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Affiliation(s)
- Tina B McKay
- Department of Ophthalmology, Schepens Eye Research Institute / Mass Eye and Ear, 20 Staniford Street, Boston, MA, 02114, USA
| | - Ursula Schlötzer-Schrehardt
- Department of Ophthalmology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sonali Pal-Ghosh
- Department of Anatomy and Cell Biology, The George Washington School of Medicine and Health Sciences, Washington, DC, 20052, USA
| | - Mary Ann Stepp
- Department of Anatomy and Cell Biology, The George Washington School of Medicine and Health Sciences, Washington, DC, 20052, USA; Department of Ophthalmology, The George Washington School of Medicine and Health Sciences, Washington, DC, 20052, USA.
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15
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de Oliveira RC, Wilson SE. Descemet's membrane development, structure, function and regeneration. Exp Eye Res 2020; 197:108090. [PMID: 32522478 DOI: 10.1016/j.exer.2020.108090] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
Basement membranes are layers of extracellular matrix which anchor the epithelium or endothelium to connective tissues in most organs. Descemet's membrane- which is the basement membrane for the corneal endothelium- is a dense, thick, relatively transparent and cell-free matrix that separates the posterior corneal stroma from the underlying endothelium. It was historically named Descemet's membrane after Jean Descemet, a French physician, but it is also known as the posterior limiting elastic lamina, lamina elastica posterior, and membrane of Demours. Normal Descemet's membrane ultrastructure in humans has been shown to consist of an interfacial matrix that attaches to the overlying corneal stroma, an anterior banded layer and a posterior non-banded layer-upon which corneal endothelial cells attach. These layers have been shown to have unique composition and morphology, and to contribute to corneal homeostasis and clarity, participate in the control of corneal hydration and to modulate TGF-β-induced posterior corneal fibrosis. Pathophysiological alterations of Descemet's membrane are noted in ocular diseases such as Fuchs' dystrophy, bullous keratopathy, keratoconus, primary congenital glaucoma (Haab's striae), as well as in systemic conditions. Unrepaired extensive damage to Descemet's membrane results in severe corneal opacity and vision loss due to stromal fibrosis, which may require penetrating keratoplasty to restore corneal transparency. The purpose of this article is to highlight the current understanding of Descemet's membrane structure, function and potential for regeneration.
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16
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Jeang L, Cha BJ, Birk DE, Espana EM. Endothelial-Stromal Communication in Murine and Human Corneas. Anat Rec (Hoboken) 2020; 303:1717-1726. [PMID: 32243086 DOI: 10.1002/ar.24393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/22/2019] [Accepted: 12/31/2019] [Indexed: 12/13/2022]
Abstract
The purpose of this study is to identify and characterize interactions of corneal endothelial cells with the posterior stroma. Corneal endothelial-stromal interactions were examined in developing postnatal day 3 (P3) and mature postnatal day 30 (P30) C57BL/6 mice and adult human corneas. Flat mounts and cross-sections were studied using immunofluorescence microscopy. F-actin was labeled with phalloidin to evaluate cell processes traversing Descemet's membrane (DM). Dynamic cell-cell communication was evaluated with fluorescence recovery after photobleaching (FRAP) using calcein acetoxymethyl dye. Endothelial-stromal interactions were observed across the whole cornea transversing DM during early postnatal development (P3), while these interactions became restricted to the periphery in the mature murine cornea (P30). In adult human corneas, endothelial extensions through the DM were observed in the peripheral cornea. The pattern of FRAP in both mature mice and human central corneas demonstrated endothelial-endothelial cell communication. In contrast, in the human cornea 2, distinct patterns were observed consistent with endothelial-endothelial and stromal-endothelial communication. Endothelial-stromal interactions were observed in the entire cornea during early postnatal mouse corneas. This evidence of endothelial-posterior stromal contact contradicts the hypothesis that corneal endothelial cells are isolated from the stroma by the DM and provides direct data to support endothelial-stromal comunication that may directly influence posterior corneal structure and function. Anat Rec, 2020. © 2020 American Association for Anatomy.
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Affiliation(s)
- Lauren Jeang
- Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Byeong J Cha
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - David E Birk
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Edgar M Espana
- Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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17
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Slenter IJM, Hermans H, Ensink JM, Willems DS, Veraa S, Grinwis GCM, Boevé MH. Clinical, ultrasonographic, and histopathologic findings in seven horses with Descemet's membrane detachment: A case series. Vet Ophthalmol 2019; 23:181-189. [PMID: 31544302 PMCID: PMC7003845 DOI: 10.1111/vop.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe ultrasonography as a diagnostic method of in vivo Descemet's membrane detachment (DMD) in horses. ANIMALS STUDIED Seven horses (three Icelandic horses, two Dutch Warmblood horses, one Appaloosa, and one Welsh Pony), presenting with moderate-to-severe focal or diffuse corneal edema, in whom DMD was suspected on ultrasonographic examination and confirmed with histopathology, were studied. PROCEDURE A retrospective analysis of case records of horses with suspected DMD was performed. RESULTS Median age at presentation was 14 years (range 11-24). Clinical signs in eyes with DMD were unilateral in all horses and included blepharospasm and epiphora (6/7), buphthalmos (5/7), moderate-to-severe focal or diffuse corneal edema (7/7), corneal epithelial bullae (4/7), corneal neovascularization (4/7), Haab's striae (2/7), corneal endothelial precipitates (1/7), fibrin in the anterior chamber (1/7), focal cataract (2/7), and pigment deposits on the anterior lens capsule (1/7). During transpalpebral ultrasonography, a distinct linear echogenic structure was noted in the anterior chamber, initially diverging from, and later running parallel to, the posterior lining of the cornea in all eyes studied. In all cases, the cornea was severely thickened and echogenic, consistent with edema, and DMD was suspected. In all horses, the clinical signs progressed and the affected eye was eventually enucleated. Histopathology revealed DMD (7/7), spindle cell proliferation (4/7), Descemet's membrane reformation (3/7), and inflammation of the anterior uvea (5/7). Overall incidence was 1.04%. CONCLUSIONS Ultrasonography is an adequate tool in diagnosing DMD in horses. Descemet's membrane detachment should be included in the differential diagnosis in horses with dense focal or diffuse corneal edema.
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Affiliation(s)
- Inge J M Slenter
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
| | - Hanneke Hermans
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Jos M Ensink
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Dorien S Willems
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Stefanie Veraa
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Faculty of Veterinary Medicine, Department of Pathobiology, Utrecht University, Utrecht, The Netherlands
| | - Michael H Boevé
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
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18
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Hutcheon AEK, Zieske JD, Guo X. 3D in vitro model for human corneal endothelial cell maturation. Exp Eye Res 2019; 184:183-191. [PMID: 30980816 DOI: 10.1016/j.exer.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/15/2019] [Accepted: 04/04/2019] [Indexed: 12/12/2022]
Abstract
Corneal endothelium is a cellular monolayer positioned on the Descemet's membrane at the anterior cornea, and it plays a critical role in maintaining corneal clarity. Our present study examines the feasibility of utilizing our 3-dimensional (3D) corneal stromal construct, which consists of human corneal fibroblasts (HCF) and their self-assembled matrix, to observe the development and maturation of human corneal endothelial cells (HCEndoCs) in a co-culture model. Three-dimensional HCF constructs were created by growing the HCFs on Transwell membranes in Eagles' minimum essential medium (EMEM) + 10% FBS + 0.5 mM Vitamin C (VitC) for about 4 weeks. HCEndoCs, either primary (pHCEndoC) or cell line (HCEndoCL), were either seeded in chamber slides, directly on the Transwell membranes, or on the 3D HCF constructs and cultivated for 5 days or 2 weeks. The HCEndoCs that were seeded directly on the Transwell membranes were exposed indirectly to HCF by culturing the HCF on the plate beneath the membrane. Cultures were examined for morphology and ultrastructure using light and transmission electron microscopy (TEM). In addition, indirect-immunofluorescence microscopy (IF) was used to examine tight junction formation (ZO-1), maturation (ALDH1A1), basement membrane formation (Laminin), cell proliferation (Ki67), cell death (caspase-3), and fibrotic response (CTGF). As expected, both pHCEndoCs and HCEndoCLs formed monolayers on the constructs; however, the morphology of the HCEndoCLs appeared to be similar to that seen in vivo, uniform and closely packed, whereas the pHCEndoCs remained elongated. The IF data showed that laminin localization was present in the HCEndoCs' cytoplasm as cell-cell contact increased, and when they were grown in the 3D co-culture, the beginnings of what appears to be a continuous DM-like structure was observed. In addition, in co-cultures, ALDH1A1-positive HCEndoCs were present, ZO-1 expression localized within the tight junctions, minimal numbers of HCEndoCs were Ki67-or Caspase-3-positive, and CTGF was positive in both the HCEndoCs cytoplasm and the matrix of the co-culture. Also, laminin localization was stimulated in HCEndoCs upon indirect stimuli secreted by HCF. The present data suggests our 3D co-culture model is useful for studying corneal endothelium maturation in vitro since the co-culture promotes new DM-like formation, HCEndoCs develop in vivo-like characteristics, and the fibrotic response is activated. Our current findings are applicable to understanding the implications of corneal endothelial injection therapy, such as if the abnormal DM has to be removed from the patient, the newly injected endothelial cells will seed onto the wound area and deposit a new DM-like membrane. However, caution should be observed and as much of the normal DM should be left intact since removal of the DM can cause a posterior stromal fibrotic response.
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Affiliation(s)
- Audrey E K Hutcheon
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA.
| | - James D Zieske
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA.
| | - Xiaoqing Guo
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA.
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19
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Lin J, Hassanaly S, Hyde RA, Brown J, Yoon D, Yu CQ. Late detachment of Descemet's membrane after penetrating keratoplasty for pellucid marginal degeneration. Am J Ophthalmol Case Rep 2018; 13:151-153. [PMID: 30766935 PMCID: PMC6350212 DOI: 10.1016/j.ajoc.2018.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/04/2018] [Accepted: 12/17/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose we report a case of late spontaneous large detachment of Descemet's membrane in recurrent pellucid marginal degeneration after penetrating keratoplasty. Observations a 73-year-old man presented to clinic with spontaneous detachment of his Descemet's membrane 30 years after penetrating keratoplasty for pellucid marginal degeneration. Efforts were made to bubble the membrane back into place without success. The patient then underwent endothelial keratoplasty with successful restoration of cornea clarity. Conclusions and importance this condition may cause diagnostic and treatment dilemmas if not properly identified and managed. In addition this case has information for both the use of scleral contact lens and the success of endothelial keratoplasty in an extremely steep cornea.
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Affiliation(s)
- Jonathan Lin
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, 1855 W Taylor Street, Chicago, IL 60612, USA
| | - Salima Hassanaly
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, 1855 W Taylor Street, Chicago, IL 60612, USA
| | - Robert A Hyde
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, 1855 W Taylor Street, Chicago, IL 60612, USA
| | - Jennifer Brown
- Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612, USA
| | - Dan Yoon
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, 1855 W Taylor Street, Chicago, IL 60612, USA
| | - Charles Q Yu
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, 1855 W Taylor Street, Chicago, IL 60612, USA
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20
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Leonard BC, Jalilian I, Raghunathan VK, Wang W, Jun AS, Murphy CJ, Thomasy SM. Biomechanical changes to Descemet's membrane precede endothelial cell loss in an early-onset murine model of Fuchs endothelial corneal dystrophy. Exp Eye Res 2018; 180:18-22. [PMID: 30471280 DOI: 10.1016/j.exer.2018.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 01/20/2023]
Abstract
Early-onset Fuchs endothelial corneal dystrophy (FECD) has been associated with nonsynonymous mutations in collagen VIII α2 (COL8A2), a key extracellular matrix (ECM) protein in Descemet's membrane (DM). Two knock-in strains of mice have been generated to each express a mutant COL8A2 protein (Col8a2L450W/L450W and Col8a2Q455K/Q455K) that recapitulate the clinical phenotype of early-onset FECD including endothelial cell loss, cellular polymegathism and pleomorphism, and guttae. Due to abnormalities in ECM protein composition and structure in FECD, the stiffness of DM in Col8a2 knock-in mice and wildtype (WT) controls was measured using atomic force microscopy at 5 and 10 months of age, coinciding with the onset of FECD phenotypic abnormalities. At 5 months, only sporadic guttae were identified via in vivo confocal microscopy (IVCM) in Col8a2Q455K/Q455K mice, otherwise both strains of Col8a2 transgenic mice were indistinguishable from WT controls in terms of endothelial cell density and size. By 10 months of age, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice developed reduced corneal endothelial density, increased endothelial cell area and guttae, with the Col8a2Q455K/Q455K strain exhibiting a more severe phenotype. However, at 5 months of age, prior to the development endothelial cell abnormalities, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice knock-in mice had reduced tissue stiffness of DM that was statistically significant in the Col8a2Q455K/Q455K mice when compared with wildtype controls. These data indicate that alterations in the tissue compliance of DM precede phenotypic changes in endothelial cell count and morphology, and may play a role in onset and progression of FECD.
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Affiliation(s)
- Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States
| | - Iman Jalilian
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States
| | - Vijay Krishna Raghunathan
- The Ocular Surface Institute, University of Houston, Houston, TX, United States; Department of Basic Sciences, College of Optometry, University of Houston, Houston, TX, United States; Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX, United States
| | - Wei Wang
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States; Department of Ophthalmology & Vision Sciences, School of Medicine, University of California, Davis, CA, United States
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States; Department of Ophthalmology & Vision Sciences, School of Medicine, University of California, Davis, CA, United States.
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21
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Ruland K, Bouldin TW, Davis RM, Fleischman D. Intraoperative optical coherence tomography-assisted retrocorneal fibrous membrane biopsy and excision. Am J Ophthalmol Case Rep 2018; 11:101-104. [PMID: 29998208 PMCID: PMC6038824 DOI: 10.1016/j.ajoc.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/10/2018] [Accepted: 06/19/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose We report a case of retrocorneal fibrous membrane (RCFM) formation following penetrating keratoplasty (PK) and intraoperative optical coherence tomography (OCT)-guided excision of this membrane. Observations A 68-year-old woman with primary open angle glaucoma and corneal decompensation of the right eye secondary to tube shunt presented for 3-month follow-up of PK. On examination of the right eye, the patient was noted to have a glassy pupillary membrane with traction on the iris. Anterior segment OCT confirmed a membrane connecting the iris to host cornea. The patient underwent biopsy and excision of the membrane assisted by intraoperative OCT. Pathological examination was consistent with Descemet's membrane proliferation. We suspect that this membrane represents retained host's Descemet's membrane following corneal transplantation. Conclusions This case highlights the existence of RCFM formation in the context of retained host cornea following PK and the role of intraoperative OCT in management.
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Affiliation(s)
- Kelly Ruland
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA, 19129, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, CB# 7525, Brinkhous-Bullitt Bldg, Chapel Hill, NC, 27599-7525, USA
| | - Richard M Davis
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Kittner Eye Center, 2226 Nelson Highway, Chapel Hill, NC 27517, USA
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Kittner Eye Center, 2226 Nelson Highway, Chapel Hill, NC 27517, USA
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22
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Loh IP, Fan Gaskin JC, Sherwin T, McGhee CNJ. Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations. Am J Ophthalmol Case Rep 2018; 10:271-275. [PMID: 29780950 PMCID: PMC5956727 DOI: 10.1016/j.ajoc.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the clinical and histological manifestations of an extreme Descemet's membrane rupture as a result of keratoconus. Observations Using Periodic acid-Schiff assay to study a keratoconic cornea with an extreme rupture showed that the ruptured Descemet's membrane had retracted and folded into scrolls and ridges. The dimensions of the rupture were estimated to be 3.7mm2, and the central cornea was extremely thinned with a thickness of only 260μm. Stromal scarring and loosely packed lamellae were present anterior to the scrolls and ridges. Antibodies targetting the major components of Descemet's membrane, Laminin and type IV collagen, displayed intense labelling adjacent to the scrolls where the stroma was denuded and differential expression patterns lined the ridges. Environmental scanning electron microscopy showed possible collagen deposition at the site of rupture. Conclusions and importance The specific staining patterns of laminin and type IV collagen suggest these components have an important role in re-endothelisation of the cornea. This is the first known report of spatial resolution of the topography of the Descemet's membrane rupture established by environmental scanning electron microscopic image montage.
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Affiliation(s)
- I-Ping Loh
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Jennifer C Fan Gaskin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
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23
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Marino GK, Santhiago MR, Santhanam A, Lassance L, Thangavadivel S, Medeiros CS, Bose K, Tam KP, Wilson SE. Epithelial basement membrane injury and regeneration modulates corneal fibrosis after pseudomonas corneal ulcers in rabbits. Exp Eye Res 2017; 161:101-5. [PMID: 28506643 DOI: 10.1016/j.exer.2017.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/04/2017] [Accepted: 05/11/2017] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate whether myofibroblast-related fibrosis (scarring) after microbial keratitis was modulated by the epithelial basement membrane (EBM) injury and regeneration. Rabbits were infected with Pseudomonas aeruginosa after epithelial scrape injury and the resultant severe keratitis was treated with topical tobramycin. Corneas were analyzed from one to four months after keratitis with slit lamp photos, immunohistochemistry for alpha-smooth muscle actin (α-SMA) and monocyte lineage marker CD11b, and transmission electron microscopy. At one month after keratitis, corneas had no detectible EBM lamina lucida or lamina densa, and the central stroma was packed with myofibroblasts that in some eyes extended to the posterior corneal surface with damage to Descemet's membrane and the endothelium. At one month, a nest of stromal cells in the midst of the SMA + myofibroblasts in the stroma that were CD11b+ may be fibrocyte precursors to myofibroblasts. At two to four months after keratitis, the EBM fully-regenerated and myofibroblasts disappeared from the anterior 60-90% of the stroma of all corneas, except for one four-month post-keratitis cornea where anterior myofibroblasts were still present in one localized pocket in the cornea. The organization of the stromal extracellular matrix also became less disorganized from two to four months after keratitis but remained abnormal compared to controls at the last time point. Myofibroblasts persisted in the posterior 10%-20% of posterior stroma even at four months after keratitis in the central cornea where Descemet's membrane and the endothelium were damaged. This study suggests that the EBM has a critical role in modulating myofibroblast development and fibrosis after keratitis-similar to the role of EBM in fibrosis after photorefractive keratectomy. Damage to EBM likely allows epithelium-derived transforming growth factor beta (TGFβ) to penetrate the stroma and drive development and persistence of myofibroblasts. Eventual repair of EBM leads to myofibroblast apoptosis when the cells are deprived of requisite TGFβ to maintain viability. The endothelium and Descemet's membrane may serve a similar function modulating TGFβ penetration into the posterior stroma-with the source of TGFβ likely being the aqueous humor.
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Di Mundo R, Recchia G, Parekh M, Ruzza A, Ferrari S, Carbone G. Sensing inhomogeneous mechanical properties of human corneal Descemet's membrane with AFM nano-indentation. J Mech Behav Biomed Mater 2017; 74:21-27. [PMID: 28525820 DOI: 10.1016/j.jmbbm.2017.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
The paper describes a highly space-resolved characterization of the surface mechanical properties of the posterior human corneal layer (Descemet's membrane). This has been accomplished with Atomic Force Microscopy (AFM) nano-indentation by using a probe with a sharp tip geometry. Results indicate that the contact with this biological tissue in liquid occurs with no (or very low) adhesion. More importantly, under the same operating conditions, a broad distribution of penetration depth can be measured on different x-y positions of the tissue surface, indicating a high inhomogeneity of surface stiffness, not yet clearly reported in the literature. An important contribution to such inhomogeneity should be ascribed to the discontinuous nature of the collagen/proteoglycans fibers matrix tissue, as can be imaged by AFM when the tissue is semi-dry. Using classical contact mechanics calculations adapted to the specific geometry of the tetrahedral tip it has been found that the elastic modulus E of the material in the very proximity of the surface ranges from 0.23 to 2.6 kPa.
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Affiliation(s)
- Rosa Di Mundo
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, v.le Japigia 182, 70126 Bari, Italy
| | - Giuseppina Recchia
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, v.le Japigia 182, 70126 Bari, Italy
| | - Mohit Parekh
- International Center for Ocular Physiopathology, The Veneto Eye bank Foundation, Venice, Italy
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, The Veneto Eye bank Foundation, Venice, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Veneto Eye bank Foundation, Venice, Italy
| | - Giuseppe Carbone
- Department of Mechanics, Mathematics and Management, Politecnico di Bari, v.le Japigia 182, 70126 Bari, Italy.
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Samarawickrama C, Beltz J, Chan E. Descemet's membrane detachments post cataract surgery: a management paradigm. Int J Ophthalmol 2016; 9:1839-1842. [PMID: 28003989 DOI: 10.18240/ijo.2016.12.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Descemet's membrane detachments (DMD) are relatively common after cataract surgery and most do not require any treatment. However, if large DMD are not treated appropriately, significant visual morbidity can ensue. We aim to develop a guideline for the management of DMD post cataract surgery based on a retrospective review of all cases encountered at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia over a 4-year period from 2010 to 2014. We suggest conservative management if the visual axis is not involved; however, after 3mo surgical intervention may be warranted to prevent corneal sequelae. In cases where the visual axis is involved we suggest early intervention with air tamponade. The main risk factor for irreversible corneal oedema and subsequent endothelial transplant appears to be direct endothelial trauma rather than the DMD itself.
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Affiliation(s)
- Chameen Samarawickrama
- University of Sydney, Sydney 2000, Australia; Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia
| | - Jacqueline Beltz
- Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia; Centre for Eye Research Australia, University of Melbourne, Melbourne 3002, Australia
| | - Elsie Chan
- Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia; Centre for Eye Research Australia, University of Melbourne, Melbourne 3002, Australia
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Abstract
Background To present an intraoperative acute Descemet's fold formation using swept-source optical coherence tomography (SS-OCT) imaging. Case Report A 67-year-old man complaining of reduced visual acuity in the left eye. A 25-gauge pars plana vitrectomy combined with phacoemulsification cataract surgery was performed to remove the vitreomacular traction. When hydro-sealing was performed, striae rapidly spread in the cornea. SS-OCT B-scan images performed on postoperative day 1 revealed a wavy Descemet's membrane that might correspond to Descemet's folds. Pairs of hypo- and hyperreflective narrow lesions running from the wavy Descemet's membrane to almost half of the thickness of the whole cornea were observed. En face OCT imaging clearly showed the stromal fold, which continuously spread from the Descemet's fold. Conclusion The stromal fold might be due to the focal bulge of the stroma posteriorly caused by the rapid volume increase of the stroma which could push Descemet's membrane posteriorly, thereby forming a wavy Descemet's membrane layer.
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Affiliation(s)
- Yu Ichioka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Ali M, Raghunathan V, Li JY, Murphy CJ, Thomasy SM. Biomechanical relationships between the corneal endothelium and Descemet's membrane. Exp Eye Res 2016; 152:57-70. [PMID: 27639516 DOI: 10.1016/j.exer.2016.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/13/2016] [Indexed: 12/28/2022]
Abstract
The posterior face of the cornea consists of the corneal endothelium, a monolayer of cuboidal cells that secrete and attach to Descemet's membrane, an exaggerated basement membrane. Dysfunction of the endothelium compromises the barrier and pump functions of this layer that maintain corneal deturgesence. A large number of corneal endothelial dystrophies feature irregularities in Descemet's membrane, suggesting that cells create and respond to the biophysical signals offered by their underlying matrix. This review provides an overview of the bidirectional relationship between Descemet's membrane and the corneal endothelium. Several experimental methods have characterized a richly topographic and compliant biophysical microenvironment presented by the posterior surface of Descemet's membrane, as well as the ultrastructure and composition of the membrane as it builds during a lifetime. We highlight the signaling pathways involved in the mechanotransduction of biophysical cues that influence cell behavior. We present the specific example of Fuchs' corneal endothelial dystrophy as a condition in which a dysregulated Descemet's membrane may influence the progression of disease. Finally, we discuss some disease models and regenerative strategies that may facilitate improved treatments for corneal dystrophies.
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Affiliation(s)
- Maryam Ali
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
| | - VijayKrishna Raghunathan
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, TX, 77204, USA.
| | - Jennifer Y Li
- Department of Ophthalmology & Vision Science, School of Medicine, UC Davis Medical Center, Sacramento, CA, 95817, USA.
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA; Department of Ophthalmology & Vision Science, School of Medicine, UC Davis Medical Center, Sacramento, CA, 95817, USA.
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
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Paz-Valiñas L, de la Fuente-Cid R, de Rojas-Silva MV, López-Rodríguez I, López-García M. [Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety]. Arch Soc Esp Oftalmol 2015; 90:164-179. [PMID: 25443458 DOI: 10.1016/j.oftal.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/06/2014] [Accepted: 09/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. METHODS Comprehensive literature search conducted in the main biomedical databases from January-May 2012. RESULTS Following a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). CONCLUSIONS In Fuchs' dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.
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Affiliation(s)
- L Paz-Valiñas
- Consellería de Sanidadem, Dirección Xeral de Innovación e Xestión da Saúde Pública, Axencia de Evaluación de Tecnoloxías Sanitarias de Galicia (avalia-t), Santiago de Compostela, La Coruña, España.
| | - R de la Fuente-Cid
- Consellería de Sanidadem, Dirección Xeral de Innovación e Xestión da Saúde Pública, Axencia de Evaluación de Tecnoloxías Sanitarias de Galicia (avalia-t), Santiago de Compostela, La Coruña, España
| | - M V de Rojas-Silva
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - I López-Rodríguez
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - M López-García
- Consellería de Sanidadem, Dirección Xeral de Innovación e Xestión da Saúde Pública, Axencia de Evaluación de Tecnoloxías Sanitarias de Galicia (avalia-t), Santiago de Compostela, La Coruña, España
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Abstract
PURPOSE To describe a case in which Descemet's membrane interfered with aqueous humor drainage through an ExPRESS mini shunt. This problem was successfully solved by Nd:YAG laser membranotomy. CASE REPORT A 70-year-old male, diagnosed with corticosteroid-induced glaucoma in his right eye, presented to our hospital. Topical betamethasone treatment was discontinued, and the patient was treated with intravenous D-mannitol and acetazolamide, followed by oral acetazolamide, oral potassium L-aspartate, topical dorzolamide hydrochloride, topical carteolol hydrochloride, and topical latanoprost. However, his right intraocular pressure (IOP) remained elevated. We performed ExPRESS shunt surgery in the patient's right eye. His postoperative IOP was initially within the normal range, but it reincreased 1 month after surgery. We found that the Descemet's membrane was interfering with both the primary (axial) and reserve orifices at the tip of the ExPRESS mini shunt. Nd:YAG laser membranotomy was performed and the patient's IOP again improved without any other medical treatment. CONCLUSION Descemet's membrane interfered with aqueous humor drainage via ExPRESS mini shunt, causing an increased IOP, which was resolved by Nd:YAG laser membranotomy.
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Affiliation(s)
- Rikiya Tamaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Masahiro Zako
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
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Abstract
A 44-year-old Hispanic male and 91-year-old Caucasian male presented to the clinic with acute vision loss and pain years after penetrating keratoplasty (PKP). Neither patient had a history of keratoconus. Both patients had a history of eye rubbing and intraocular device present in the anterior chamber. The first patient had a history of a glaucoma drainage tube and the second patient had an anterior chamber intraocular lens implanted. Anterior segment ocular coherence tomography showed deep stromal cystic cavities. Both patients exhibited breaks in the endothelium by ultrasound biomicroscopy and the histopathologic examination after repeat PKP. Those findings were most consistent with acute corneal hydrops in the donor graft.
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Affiliation(s)
- John B Cason
- Department of Ophthalmology, Naval Medical Center San Diego, San Diego, USA
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Srivastava VK, Singh A, Chowdhary R. Spontaneous Resolution of Corneal Oedema after Inadvertent Descemetorhexis during Cataract Surgery. Med J Armed Forces India 2011; 66:177-9. [PMID: 27375333 DOI: 10.1016/s0377-1237(10)80142-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 02/08/2010] [Indexed: 11/25/2022] Open
Affiliation(s)
- V K Srivastava
- Consultant (Ophthalmology), Command Hospital (EC), Kolkata
| | - A Singh
- Classified Specialist (Ophthalmology), MH Danapur
| | - R Chowdhary
- Graded Specialist (Ophthalmology), MH Ahmedabad
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