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Impressum
Histopathologic evaluation of retrocorneal membranes in failed corneal grafts
Wenkel H., Calabrese S., Seitz B., Küchle M., Naumann G. O. H.
Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen
Purpose: To elucidate the frequency and typical patterns of retrocorneal
membranes in graft failure after penetrating keratoplasty.
Patients and methods: Out of all 2800 penetrating keratoplasties
performed between 1988 and 1998 all corneal buttons surgically excised
for graft failure after penetrating keratoplasty were re-evaluated histopathologically.
Out of 407 performed re-keratoplasties 371 corneal buttons (from 308 patients)
were available for examination with sufficient clinical data. There were
180 male and 128 female patients with an age range from 6 to 88 years
(median 62 years). The examined corneal buttons had been surgically excised
2 weeks to 37 years after the preceding penetrating keratoplasty (mean
3.5 years).
Results: A fibrous retrocorneal membrane was observed in 45% of
the grafts with a thickness ranging from 2µm to 520µm (median
20µm). In 38 corneas there was iris tissue attached to the cornea,
68% (26/38) of these corneas presented retrocorneal membranes. Reendothelialization
of the retrocorneal membrane was seen in 75 (45%) of the specimens. In
32% of the corneal buttons (120/371) the graft-host junction was visible.
56% of these corneas showed a retrocorneal membrane that had direct contact
to the junction area in 92%. The occurrence of a retrocorneal membrane
was not correlated to the original corneal disease leading to penetrating
keratoplasty. Retrocorneal membranes were seen in corneal buttons excised
3 months to 28 years after the preceding keratoplasty.
Conclusions: Retrocorneal fibrous membranes were frequently seen
in failed corneal grafts (45%). They seem to arise from downgrowth of
stromal keratocytes through the graft-host junction but may also be a
product of altered (metaplastic) endothelial cells.