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Recurrence of posterior polymorphous corneal dystrophy is caused by the overgrowth of the original diseased endothelium
Author(s) -
MERJAVA S,
MALINOVA E,
LISKOVA P,
ZEMANOVA Z,
MICHALOVA K,
JIRSOVA K
Publication year - 2010
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2010.301.x
Subject(s) - cytokeratin , dystrophy , pathology , endothelium , cornea , medicine , corneal endothelium , explant culture , corneal dystrophy , staining , ophthalmology , biology , immunohistochemistry , in vitro , biochemistry
Purpose To establish the origin of cells causing the recurrence of posterior polymorphous corneal dystrophy (PPCD). Methods A corneal explant obtained from a male patient suffering from PPCD, who had undergone repeat penetrating keratoplasty (female donor), was examined. Cytokeratin (CK) 19 was detected using indirect immunofluorescence to confirm the presence of abnormal epithelial‐like cells on the endothelial layer. The origin of these CK19‐positive aberrant cells was then determined using fluorescence in situ hybridization of the X and Y chromosomes. Results Two out of 559 cells evaluated (0.4%) were XX positive and CK19‐negative throughout the pathological explant. 99.6% of the endothelial cells were positive for CK19 and exhibited XY staining. These results indicate that the abnormal endothelial cells, which overgrew the posterior surface of the explant within 3.5 years, originated from the patient (XY) but not from the donor tissue (XX). Extreme aggressivity of the cells could be clinically correlated with the finding of retrocorneal membrane on the iris, anterior synechiae, corectopia and secondary glaucoma. Conclusion PPCD recurrence is caused by the abnormal proliferation and migration of the patient’s aberrant endothelium, which remained localized at the periphery of the original cornea, into the donor graft. The presence of retrocorneal membrane prior to the surgery should be considered as an indication of potential aggressive behavior of these cells and it should be taken into consideration prior to the indication of corneal grafting.