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Four cases of corneal perforation in patients with chronic graft-versus-host disease.

Inagaki E, Ogawa Y, Matsumoto Y, Kawakita T, Shimmura S, Tsubota K - Mol. Vis. (2011)

Bottom Line: Three patients were successfully treated by corneal transplantation.One patient was treated with a therapeutic soft contact lens, and the wound healed within 2 days.Immunohistochemical findings revealed an increased number of cluster of differentiation 68(+) (CD68(+)) macrophages and matrix metalloproteinase 9 (MMP-9) expression in the tissue surrounding the perforation.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT

Purpose: To report the clinical features and investigate the underlying pathological processes of spontaneous corneal perforation in patients with ocular chronic graft-versus-host disease (cGVHD).

Methods: A full ophthalmological evaluation of corneal perforation in four patients with cGVHD was performed. Three of them underwent deep anterior lamellar keratoplasty and samples from two of three patients were used for histopathological analyses.

Results: Three patients were successfully treated by corneal transplantation. One patient was treated with a therapeutic soft contact lens, and the wound healed within 2 days. The common clinical features of these patients were (1) the presence of definite dry eye related to cGVHD in 3 of 4 patients and probable dry eye in one patient, (2) a central or paracentral site of corneal ulceration and perforation, with no sign of infection, and (3) prior use of a topical or systemic corticosteroid, and/or topical non-steroidal anti-inflammatory drugs. Immunohistochemical findings revealed an increased number of cluster of differentiation 68(+) (CD68(+)) macrophages and matrix metalloproteinase 9 (MMP-9) expression in the tissue surrounding the perforation.

Conclusions: Our report extends current information on the clinical features and pathological processes of corneal perforation in cGVHD by showing increased MMP-9 expression and the accumulation of CD68(+) positive macrophages in the affected areas.

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Related in: MedlinePlus

Immunohistochemical findings (MMP9 and MMP2). A-D: Consecutive sections from the case 1 sample. A, B: Intense MMP9 expression was seen in the stroma (A, B) and epithelium (B) near the perforation. C: MMP2 expression was not observed. E: Conjunctiva sample from a cGVHD patient showing intense MMP9 expression (positive control). F: Control conjunctiva sample (negative control).
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f4: Immunohistochemical findings (MMP9 and MMP2). A-D: Consecutive sections from the case 1 sample. A, B: Intense MMP9 expression was seen in the stroma (A, B) and epithelium (B) near the perforation. C: MMP2 expression was not observed. E: Conjunctiva sample from a cGVHD patient showing intense MMP9 expression (positive control). F: Control conjunctiva sample (negative control).

Mentions: Staining for CD68 showed intense expression on mononuclear cells around the margin of the corneal ulcer in the sample from case 1 (Figure 3A), but scarcely detected in the control samples (Figure 3D). Both CD8+ (Figure 3B,E) and CD4+ (Figure 3C,F) T cells were not detected in these samples or control samles. Immunostaining for MMP9, also known as type IV collagenase, showed intense expression in the stroma (Figure 4A,B) and epithelium (Figure 4B) of the perforated cornea from a patient with cGVHD. However, no immunoreactivity for MMP2 was detected (Figure 4C). MMP9 was not detected in the negative control samples (Figure 4F).


Four cases of corneal perforation in patients with chronic graft-versus-host disease.

Inagaki E, Ogawa Y, Matsumoto Y, Kawakita T, Shimmura S, Tsubota K - Mol. Vis. (2011)

Immunohistochemical findings (MMP9 and MMP2). A-D: Consecutive sections from the case 1 sample. A, B: Intense MMP9 expression was seen in the stroma (A, B) and epithelium (B) near the perforation. C: MMP2 expression was not observed. E: Conjunctiva sample from a cGVHD patient showing intense MMP9 expression (positive control). F: Control conjunctiva sample (negative control).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3049733&req=5

f4: Immunohistochemical findings (MMP9 and MMP2). A-D: Consecutive sections from the case 1 sample. A, B: Intense MMP9 expression was seen in the stroma (A, B) and epithelium (B) near the perforation. C: MMP2 expression was not observed. E: Conjunctiva sample from a cGVHD patient showing intense MMP9 expression (positive control). F: Control conjunctiva sample (negative control).
Mentions: Staining for CD68 showed intense expression on mononuclear cells around the margin of the corneal ulcer in the sample from case 1 (Figure 3A), but scarcely detected in the control samples (Figure 3D). Both CD8+ (Figure 3B,E) and CD4+ (Figure 3C,F) T cells were not detected in these samples or control samles. Immunostaining for MMP9, also known as type IV collagenase, showed intense expression in the stroma (Figure 4A,B) and epithelium (Figure 4B) of the perforated cornea from a patient with cGVHD. However, no immunoreactivity for MMP2 was detected (Figure 4C). MMP9 was not detected in the negative control samples (Figure 4F).

Bottom Line: Three patients were successfully treated by corneal transplantation.One patient was treated with a therapeutic soft contact lens, and the wound healed within 2 days.Immunohistochemical findings revealed an increased number of cluster of differentiation 68(+) (CD68(+)) macrophages and matrix metalloproteinase 9 (MMP-9) expression in the tissue surrounding the perforation.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT

Purpose: To report the clinical features and investigate the underlying pathological processes of spontaneous corneal perforation in patients with ocular chronic graft-versus-host disease (cGVHD).

Methods: A full ophthalmological evaluation of corneal perforation in four patients with cGVHD was performed. Three of them underwent deep anterior lamellar keratoplasty and samples from two of three patients were used for histopathological analyses.

Results: Three patients were successfully treated by corneal transplantation. One patient was treated with a therapeutic soft contact lens, and the wound healed within 2 days. The common clinical features of these patients were (1) the presence of definite dry eye related to cGVHD in 3 of 4 patients and probable dry eye in one patient, (2) a central or paracentral site of corneal ulceration and perforation, with no sign of infection, and (3) prior use of a topical or systemic corticosteroid, and/or topical non-steroidal anti-inflammatory drugs. Immunohistochemical findings revealed an increased number of cluster of differentiation 68(+) (CD68(+)) macrophages and matrix metalloproteinase 9 (MMP-9) expression in the tissue surrounding the perforation.

Conclusions: Our report extends current information on the clinical features and pathological processes of corneal perforation in cGVHD by showing increased MMP-9 expression and the accumulation of CD68(+) positive macrophages in the affected areas.

Show MeSH
Related in: MedlinePlus