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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

Hypothetical etiology of corneal perforation in cGVHD patients. CD68+ macrophages engulf and degrade the recipient’s degenerated epithelium as a foreign body, leading to the secretion of a large amount of proinflammatory cytokines, and the subsequent expression of MMP9 on macrophages or the corneal stroma and epithelium.
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f5: Hypothetical etiology of corneal perforation in cGVHD patients. CD68+ macrophages engulf and degrade the recipient’s degenerated epithelium as a foreign body, leading to the secretion of a large amount of proinflammatory cytokines, and the subsequent expression of MMP9 on macrophages or the corneal stroma and epithelium.

Mentions: In addition, sections through the corneal perforation site of our cases 1 and 4 showed an increased infiltration of CD68+ macrophages and immunostaining for MMP9. The accumulation of CD68+ macrophages at the site of corneal perforation reflects local immune responses, including the inflammatory response. CD68+ macrophages might engulf and destroy the recipient’s damaged corneal tissues, leading to the release of large amounts of pro-inflammatory cytokines and inducing the expression of MMPs (Figure 5), but it is not clear whether the CD68+ macrophage infiltration is a primary event, which may induce corneal perforation, or a response to it. Further study is needed to clarify this issue.


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)

Hypothetical etiology of corneal perforation in cGVHD patients. CD68+ macrophages engulf and degrade the recipient’s degenerated epithelium as a foreign body, leading to the secretion of a large amount of proinflammatory cytokines, and the subsequent expression of MMP9 on macrophages or the corneal stroma and epithelium.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5: Hypothetical etiology of corneal perforation in cGVHD patients. CD68+ macrophages engulf and degrade the recipient’s degenerated epithelium as a foreign body, leading to the secretion of a large amount of proinflammatory cytokines, and the subsequent expression of MMP9 on macrophages or the corneal stroma and epithelium.
Mentions: In addition, sections through the corneal perforation site of our cases 1 and 4 showed an increased infiltration of CD68+ macrophages and immunostaining for MMP9. The accumulation of CD68+ macrophages at the site of corneal perforation reflects local immune responses, including the inflammatory response. CD68+ macrophages might engulf and destroy the recipient’s damaged corneal tissues, leading to the release of large amounts of pro-inflammatory cytokines and inducing the expression of MMPs (Figure 5), but it is not clear whether the CD68+ macrophage infiltration is a primary event, which may induce corneal perforation, or a response to it. Further study is needed to clarify this issue.

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