Conjunctival Resection for the Treatment of Superior Limbic Keratoconjunctivitis (SLK) and the Involvement of Mast Cells and Matrix Metalloproteinases in SLK
Date Issued
2006
Date
2006
Author(s)
Sun, Yi-Chen
DOI
zh-TW
Abstract
Although medication therapy for this not unusual disease, superior limbic keraconjunctivitis (SLK) had been done for years, failed results after this conservative treatment are commonly seen. Mostly, these patients with poor response to medication will be arranged conjunctival resection as therapy. Unfortunately, large scale of study for the effectiveness evaluation is absent. Therefore, we intend to explore the effectiveness of conjunctival resection in treating superior limbic keratoconjunctivitis (SLK) and the role of mast cell and matrix metalloproteinase (MMP) in SLK.
In this study, 40 eyes from 30 SLK patients since 1992 to 2005, who were unresponsive to medical treatment received superior bulbar conjunctival resection were selected. Another 20 patients from cataract and retinal surgery were served as control group. The conjunctiva specimens were examined by H-E stain and immunohistochemistry (IHC) using antibodies against mast cell tryptase, MMP-1, -2 and -3. All the fresh conjunctiva tissue including SLK group and control group were also processed to extract the total mRNA. Using MMP-1, -2, -3 and -9 as the primer, reverse transcription and polymerase chain reaction (RT-PCR) were also done in this study,
In all operated eyes, the clinical symptoms and signs, including irritation/redness and superior bulbar conjunctival hyperemia / superior tarsal conjunctival papillary hypertrophy, subsided significantly one month after the operation. Only 3 eyes had recurrence from the margin of conjunctival resection, which were relieved after re-operation. Keratinized conjunctival epithelium, loss of goblet cells, increased mast cell numbers (P=0.004) and overexpression of MMP-1 and MMP-3 (P<0.0001) were found in SLK group. The results of RT-PCR were also compatible to that of IHC with the up-regulation of MMP-1 and MMP-3.
Conclusively, our results demonstrate that superior bulbar conjunctival resection is an effective and safe treatment modality for SLK. The findings of immunohistochemistry and reverse transcription and polymerase chain reaction suggested that mast cells and up-regulation of MMPs play some roles in the pathogenesis of SLK.
Subjects
上輪部角結膜炎
肥胖細胞
基質金屬蛋白酵素
Superior limbic keratoconjuncitivitis
Mast cell
Matrix metalloproteinase
Type
text
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