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Recurrent Meesmann's corneal epithelial dystrophy after penetrating keratoplasty
A G Chiou1, G J Florakis, R L Copeland
1Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, New York 10032, USA.
Purpose:
To characterize the histopathology of recurrent Meesmann's corneal epithelial dystrophy after penetrating keratoplasty.
Methods:
Postmortem examination by light and electron microscopy of the eyes of an 84-year-old patient with Meesmann's dystrophy who underwent a penetrating keratoplasty in the right eye at age 74 years and a lamellar keratoplasty in the left eye at age 51 years.
Results:
In the right eye, the characteristic features of Meesmann's dystrophy were demonstrated in both the donor and recipient corneas. The pathologic findings were limited to the corneal epithelium and included increased thickness, architectural disorganization, loss of cell polarity, increased amounts of intracellular glycogen, presence of intraepithelial microcysts containing degenerated cells, and in some cells, the presence of an electron-dense fibrillogranular material associated with disrupted cytoplasmic filaments. In the left eye, the corneal findings were consistent with but not specific for Meesmann's dystrophy. These included architectural disorganization, loss of cell polarity, presence of intraepithelial microcysts, and irregular thickening of the basement membrane in the donor cornea.
Conclusion:
Meesmann's corneal epithelial dystrophy is demonstrated to recur after penetrating keratoplasty. This finding suggests that the abnormalities that lead to the disease are localized to the corneal epithelial cells and not in the stroma, as previously proposed.
Insights
Meesmann's corneal epithelial dystrophy recurs after penetrating keratoplasty, indicating the disease originates in corneal epithelial cells. Histopathology confirmed dystrophy in donor and recipient tissues.
Area of Science:
- Ophthalmology
- Histopathology
- Corneal Diseases
Background:
- Meesmann's corneal epithelial dystrophy (MCED) is a rare, inherited condition affecting the cornea.
- Previous understanding suggested stromal involvement, but recurrence post-keratoplasty prompted re-evaluation.
Observation:
- A postmortem examination analyzed eyes from a patient with MCED who underwent penetrating and lamellar keratoplasty.
- Histopathology utilized light and electron microscopy to examine corneal tissues.
Findings:
- Meesmann's dystrophy recurred in both donor and recipient corneas after penetrating keratoplasty, limited to the corneal epithelium.
- Characteristic findings included epithelial thickening, disorganization, loss of polarity, increased glycogen, microcysts, and abnormal intracellular material.
- Lamellar keratoplasty also showed some dystrophy features in the donor cornea.
Implications:
- The recurrence of Meesmann's dystrophy after penetrating keratoplasty confirms its epithelial origin.
- This challenges prior theories suggesting stromal involvement in the disease pathogenesis.
- Understanding the epithelial basis is crucial for future treatment strategies for Meesmann's dystrophy.