Long-standing bullous keratopathy is associated with peripheral conjunctivalization and limbal deficiency.
OBJECTIVE
To investigate whether peripheral corneal neovascularization in bullous keratopathy (BK) is due to conjunctivalization, a sign of limbal stem cell deficiency.


METHODS
Observational case-control study.


METHODS
Sixteen BK patients.


METHODS
Patients were divided into 2 groups: BK without peripheral neovascularization [NV(-) group; 5 patients, 5 eyes] and BK with neovascularization [NV(+) group; 11 patients, 13 eyes]. Evidence of conjunctivalization was evaluated by periodic acid-Schiff staining of impression cytology samples from the peripheral vascularized cornea. The 2 groups' durations of disease also were compared. Penetrating keratoplasty (PK) was performed in all 16 cases, and the 2 groups' durations of reepithelialization after PK were compared.


METHODS
Presence of goblet cells using impression cytology, duration of BK, and duration of postoperative reepithelialization.


RESULTS
Goblet cells were found on the peripheral corneal surface in all eyes in the NV(+) group. However, all eyes in the NV(-) group were negative for goblet cells (P<0.0001). Duration of disease was 14.4+/-5.4 months in the NV(-) group and 66.2+/-65.5 months in the NV(+) group (P = 0.030). Duration of postoperative epithelialization was 6.2+/-2.2 days in the NV(-) group and 28.8+/-36.5 days in the NV(+) group (P = 0.046).


CONCLUSIONS
Conjunctivalization of the peripheral cornea and delayed postoperative epithelialization in BK patients with NV suggest the presence of limbal stem cell deficiency in such patients. Patients with long-standing disease were found to be more prone to neovascularization. For this reason, early surgery may lead to a better surgical outcome.
Uchino
Yuichi
Y
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Goto
Eiki
E
Takano
Yoji
Y
Dogru
Murat
M
Shinozaki
Naoshi
N
Shimmura
Shigeto
S
Yagi
Yukiko
Y
Tsubota
Kazuo
K
Shimazaki
Jun
J
D000368:Aged; D016022:Case-Control Studies; D003228:Conjunctiva / Q000473:pathology*; D003316:Corneal Diseases / Q000175:diagnosis* / Q000601:surgery; D016510:Corneal Neovascularization / Q000175:diagnosis / Q000601:surgery; D003584:Cytological Techniques; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D015948:Keratoplasty, Penetrating; D016850:Limbus Corneae; D008297:Male; D008875:Middle Aged; D010503:Periodic Acid-Schiff Reaction; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*