title: Phenotypic Investigation of Regenerated Epithelial Cells After Gonococcal Corneal Perforation: A Clinical, Histological, and Immunohistochemical Study.
abstract: OBJECTIVE
  To determine the characteristics of regenerated epithelial cells after severe gonococcal infection after corneal perforation.
  
  
  METHODS
  Pathological tissue was obtained from the cornea at the time of surgery. Hematoxylin and eosin staining and immunohistochemical analysis were performed for cytoskeletal keratins (K12, K13, and K15), basement membrane and junctional markers (laminin 5, ZO-1 and Desmoplakin), and proliferative and mesenchymal markers (Ki67, α-SMA, and vimentin).
  
  
  RESULTS
  A 42-year-old patient with severe gonococcal keratoconjunctivitis rapidly progressed to corneal perforation during administration of intensive topical and systemic antibiotics. After conservative treatment, the perforation healed and 5- × 3-mm corneal ectasia occurred with localized iris attachment. Complete closure of the cornea was confirmed by a negative Seidel test. After lamellar keratoplasty to improve corneal integrity and to prevent secondary glaucoma, the pathological tissue revealed a poorly organized epithelial layer at the regenerated ectatic area. The regenerated epithelial cells clearly expressed K12, ZO-1, and Desmoplakin with underlying laminin 5 (+) basement membrane. K15 and Ki67 expressions were observed predominantly at the limbal area but not in the regenerated area. α-SMA and vimentin were sporadically expressed in the underlying connective tissue.
  
  
  CONCLUSIONS
  We speculate that the process of epithelial wound healing at the site of corneal perforation was responsible for migration of the surrounding epithelial cells. Although the regenerated cells expressed several cytokeratins and junctional markers, they remained disorganized and fragile.
authors.affiliation: *Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; †Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and ‡Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Passara
authors.initials: P
authors.lastname: Jongkhajornpong
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000199:Actins / Q000378:metabolism; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002465:Cell Movement / Q000502:physiology; D057112:Corneal Perforation / Q000378:metabolism / Q000382:microbiology / Q000601:surgery*; D016039:Corneal Transplantation; D004847:Epithelial Cells / Q000166:cytology; D019573:Epithelium, Corneal / Q000502:physiology*; D015818:Eye Infections, Bacterial / Q000378:metabolism / Q000382:microbiology / Q000601:surgery*; D006069:Gonorrhea / Q000378:metabolism / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000378:metabolism; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D010641:Phenotype; D012038:Regeneration / Q000502:physiology*; D062725:Tight Junction Proteins / Q000378:metabolism; D014746:Vimentin / Q000378:metabolism; D014945:Wound Healing / Q000502:physiology
chemical_list: C541116:ACTA2 protein, human; D000199:Actins; D015415:Biomarkers; D019394:Ki-67 Antigen; D062725:Tight Junction Proteins; D014746:Vimentin; D007633:Keratins