78例失败穿透角膜移植片的组织病理学研究  

Histopathology of failed corneal grafts after penetrating keratoplasty

作　　者：郑天玉[1] 洪佳旭[1] 徐建江[1] 王欣[1] 陈荣家[1] 毕颖文[1] 

机构地区：[1]上海复旦大学附属眼耳鼻喉科医院眼科,200031

出　　处：《眼科研究》2009年第4期301-306,共6页Chinese Ophthalmic Research

基　　金：国家自然科学基金(30872815);卫生部部属(管)医院临床学科重点项目(2007~2009年)资助

摘　　要：目的通过观察穿透角膜移植(PKP)失败植片的组织病理学改变,探讨不同原因所致移植失败的组织病理学演变过程。方法对行二次PKP取下的78例失败角膜植片行组织病理学检查。将植片按移植失败原因分为4组,将各组植片按原发病归类,光学显微镜下观察组织病理学表现。结果原发病复发组呈现与原发病相似的组织病理学表现。排斥组植片的各层结构基本存在,伴有炎症、成纤维细胞活跃和角膜新生血管(CNV)生长。根据原发病和二次手术时机的不同,又各有不同特点。植片溃疡组中,根据原发病不同呈现以慢性或急性炎性细胞浸润的不同表现。内皮失代偿组植片结构破坏较轻,均以上皮大泡和基质板层变性为主要病理学表现。结论PKP失败植片的组织病理学改变提示了各种移植失败原因的不同病理学演变过程。Objective To demonstrate the pathological courses of graft failures in varied causes after penetrating keratoplasty（PKP）through histopathologic evaluation of the failed grafts. Methods Histopathologic evaluation was performed on 78 failed corneal grafts of 76 patients received a second PKP. The grafts were devided into 4 groups according to the cause of graft failure ： group A ： recurrence of the primary diseases （ 3 grafts） ; group B ： rejection （ 54 grafts） ; group C ： graft ulcer with unclear causes（15 grafts） ; group D： failure of the endothelial function without graft rejection （6 grafts）. Grafts of each group were classified on their primary diseases and observed for the histopathological characteristics with their amount of acute and chronic inflammatory cells and corneal neovasculars （CNVs） counted. Results Grafts in group A showed similar histopathological appearance to their primary diseases. Grafts in group B showed retied histopathological appearance according to their primary diseases. Corneal burn ：Structure of grafts was seriously destroyed, with aboundant infiltration of chronic inflammantory cells and outgrowth of CNVs. Fungal infection： Structure was largely destroyed either, with evident fibroblast activity and outgrowth of CNVs. Bacteria infection, corneal trauma and keratoconus ： Structure was mildly changed, with moderate inflammation, fibroblast activity and outgrowth of CNVs,and all envolved with time. Herpes simplex keratitis（HSK） ,corneal scar and corneal dystrophy： the histopathological changes also envolved with time, and after stabilization,hardly any inflammation, fibroblast activity or CNVs were observed,with slight changes in the structure. Bullous keratopathy：Grafts showed an appearance of endothelial failure. Grafts in group C ： Grafs from patients with primary disease of fungal infection or amoebic infection showed aboundant infiltration of chronic inflammatory cells in the beginning followed by fibroblast activity and outgrowth

关 键 词：穿透角膜移植 移植失败 排斥 组织病理学 

分 类 号：R779.65[医药卫生—眼科]