小切口深板层豚鼠角膜内皮移植伤口愈合的组织病理学研究

Histopathological study of corneal wound healing in guinea pigs after deep lamellar endothelial keratoplasty with small incision

目的探讨小切口深板层角膜内皮移植术后角膜伤口愈合的组织病理学特点。方法45只豚鼠分为受体组30只(30只眼)和供体组15只(30只眼),进行同种异体深板层角膜内皮移植。受体组豚鼠右眼为术眼,左眼的正常角膜作为组织病理学对照。于术后1、2周、1、2、3、4个月分别处死受体组2只角膜恢复透明的豚鼠,取左、右眼角膜组织经内皮细胞茜素红染色、苏木素．伊红和(或)高碘酸希夫染色后行光镜检查,计数角膜基质内细胞。结果受体组有22只眼术后角膜透明,角膜内皮细胞经茜素红染色后显示植片上内皮细胞形态和排列正常,在植床与植片间存在环形的内皮细胞异型区域。光镜检查显示,术后早期在角膜板层分离的径路上,基质内细胞明显增多;植床与植片的交接处,后板层胶原纤维和后弹力层中断,后者的残端卷起;交接处的空隙由结构紊乱、细胞成分较多的组织填充;而板层界面上胶原排列整齐。术后1个月时,出现新生的后弹力层。术后3～4个月时,后弹力层和后板层连续性恢复。结论小切口深板层角膜内皮移植术的基质创口愈合特点与损伤形式有关,板层界面上胶原排列整齐,纤维化的愈合方式见于植床与植片的连接处。

Objective To study the histopathological characteristics of corneal wound healing after deep lamellar endothelial keratoplasty （DLEK）with small incision. Methods Forty-five guinea pigs were divided into the donor and recipient groups, which consisted of 15 and 30 guinea pigs respectively. DLEK was performed in the right eye, and the left eye was used as histopathological control. Two guinea pigs with clear right corneas under biomicrnscopy examination were killed at 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months postoperatively, separately. Bilateral corneal buttons were harvested for the evaluation of endothelial cells （alizarin red stain） and for the light microscopy study （HE or PAS staining）. Results Clear cornea could be obtained in 22 recipient eyes postoperatively. In these corneas, the endothelial cells either in the donor disc or recipient＇s bed were normal in shape and size. However, there was a band area between the donor disc and recipient＇s bed, where the endothelial cells were abnormal. In the early postoperative period, histopathological study disclosed increase of number of cells in the corneal stroma along the pathway of lamellar separation. The tissue connecting the gap between the donor and recipient lacked lamellar structure. The new descemet＇ s membrane appeared beneath the endothelium 1 month postoperatively. Three to four months after the operation, the continuity of the descemet＇s membrane and the posterior lamella was rehabilitated. Conclusions The corneal wound healing process after the DLEK with small incision is related with the type of trauma. Collagen is arranged well at the surface of the lamellar. Fibrotic repair is seen in the marginal area connecting the donor disc and recipient＇s bed. （Chin J Ophthalmol , 2006,42：694-698 ）