Mariantonia Ferrara,Eliana Forbice,Diego Segala,Scott Hau,Giacomo Beschi,Francesco Morescalchi,Mario R Romano,Francesco Semeraro,Vito Romano
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The AS-OCT showed corneal thickening, intrastromal scattered hyperreflective dots and large rounded/oval hyporeflective space; the latter were suggestive of emulsified HSO microbubbles and larger bubbles, respectively. In vivo confocal microscopy showed multiple presumed SO-related corneal changes, including hyper-reflective fibrotic changes in the basal epithelium, reduced density ans altered morphology of keratocytes cell population, increased pleomorphism and polymegathism of the endothelium with reduced endothelial cell, and presence of inflammatory cells. The patient underwent a penetrating keratoplasty, pupilloplasty and retropupillary iris-claw IOL implantation. The histopathological examination of the host corneal button showed Descemet's membrane irregularity and thickened corneal stroma with focal intrastromal silicone oil vacuoles, surrounded by macrophages.\r\n\r\nCONCLUSION\r\nWe described for the first time intrastromal hyperreflective dots as a sign associated with SO-related keratopathy. 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引用次数: 0
摘要
目的通过多模态成像和组织病理学检查描述硅油角膜病的特征。 结果21岁的男性患者在充注重型硫酸(HSO)的眼睛中出现右侧角膜失代偿。由于开球损伤伴角膜伤口、晶状体损伤和两个玻璃体内异物残留,患者接受了初次晶状体切除术、玻璃体旁切除术(PPV)和HSO填塞术,随后由于牵引性脱离伴增殖性玻璃体视网膜病变和视网膜外膜,患者接受了再次PPV和HSO填塞术。取出 HSO 一个月后,右眼的眼科检查显示角膜失代偿。AS-OCT 显示角膜增厚、基质内散在高反射点和大的圆形/椭圆形低反射空间;后者分别提示乳化的 HSO 微泡和较大的气泡。体内共聚焦显微镜检查显示了多种推测与 SO 有关的角膜病变,包括基底上皮的高反射性纤维化病变、角膜细胞密度降低和形态改变、内皮细胞多形性和多形性增加,内皮细胞减少,以及炎症细胞的存在。患者接受了穿透性角膜成形术、瞳孔成形术和瞳孔后虹膜爪人工晶体植入术。宿主角膜扣带的组织病理学检查显示,德斯密特膜不规则,角膜基质增厚,基质内有局灶性硅油空泡,周围有巨噬细胞。此外,本病例报告还证实了乳化硅油能够渗入角膜,诱发局部低度慢性炎症。
Multimodal imaging and histopathological evaluation in silicone oil keratopathy.
PURPOSE
To describe features in silicone oil keratopathy using multimodal imaging and histopathological examination.
METHODS
Case report.
RESULT
A 21-year-old male developed right corneal decompensation in the heavy SO (HSO)-filled eye. The patient underwent an initial lensectomy, pars plana vitrectomy (PPV) and HSO tamponade due open-globe injury with corneal wound, lens damage and in two retained intravitreal glass foreign bodies, followed by a revisional PPV with HSO tamponade due to tractional detachment associated with proliferative vitreoretinopathy and epiretinal membrane. One month after the removal of HSO, ophthalmic examination of the right eye showed corneal decompensation. The AS-OCT showed corneal thickening, intrastromal scattered hyperreflective dots and large rounded/oval hyporeflective space; the latter were suggestive of emulsified HSO microbubbles and larger bubbles, respectively. In vivo confocal microscopy showed multiple presumed SO-related corneal changes, including hyper-reflective fibrotic changes in the basal epithelium, reduced density ans altered morphology of keratocytes cell population, increased pleomorphism and polymegathism of the endothelium with reduced endothelial cell, and presence of inflammatory cells. The patient underwent a penetrating keratoplasty, pupilloplasty and retropupillary iris-claw IOL implantation. The histopathological examination of the host corneal button showed Descemet's membrane irregularity and thickened corneal stroma with focal intrastromal silicone oil vacuoles, surrounded by macrophages.
CONCLUSION
We described for the first time intrastromal hyperreflective dots as a sign associated with SO-related keratopathy. Moreover, this case report supports the ability of emulsified SO to penetrate the cornea inducing a local low-grade chronic inflammation.
期刊介绍:
The European Journal of Ophthalmology was founded in 1991 and is issued in print bi-monthly. It publishes only peer-reviewed original research reporting clinical observations and laboratory investigations with clinical relevance focusing on new diagnostic and surgical techniques, instrument and therapy updates, results of clinical trials and research findings.