Br J Ophthalmol 2001;85:437-443
( April )
The specific architecture of the anterior stroma accounts for
maintenance of corneal curvature
Linda J Müller, Elisabeth Pels, Gijs F J M Vrensen
Cornea and
Lens Research Unit, The Netherlands Ophthalmic Research Institute,
Amsterdam, Netherlands
Correspondence to: Linda J Müller, PhD, The Netherlands Ophthalmic Research
Institute, Meibergdreef 47, 1105 BA Amsterdam, Netherlands
l.mueller{at}ioi.knaw.nl
Accepted for publication 17 October 2000
AIM To
analyse the human corneal stroma in extreme hydration to discover if
its structure is responsible for corneal stability.
METHODSCorneas
in several hydration states were used: postmortem control corneas (PM;
n=3), corneas left for 1 day in phosphate buffered saline (PBS; n=4),
and corneas left for 1 day (n=4), 2 days (n=4), 3 days (n=2), and 4 days (n=4) in deionised water. All corneas were fixed under
standardised conditions and processed for light and electron
microscopy. In addition, two fresh corneas from the operating theatre
were studied which were processed 6 months after storage in sodium
cacodylate buffer.
RESULTSAfter 1 day in
deionised water maximal stromal swelling was reached which did not
change up to 4 days. The stroma of deionised water corneas (1400 µm)
was much thicker than that of PBS corneas (650 µm) and PM corneas
(450 µm). Deionised water treatment led to disappearance of all
keratocytes leaving only remnants of nuclei and large interlamellar
spaces. In these specimens the distance between the collagen fibres had
increased significantly, but the diameter of the collagen fibres did
not seem to be affected. A remarkable observation was that the most
anterior part of the stroma (100-120 µm) in all deionised water
specimens and those stored for 6 months in buffer was not swollen,
indicating that the tightly interwoven anterior lamellae are resistant
to extreme non-physiological hydration states.
CONCLUSIONSThe
rigidity of the most anterior part of the corneal stroma in extreme
hydration states points to an important role in maintenance of corneal
curvature. Since a large part of this rigid anterior part of the stroma
is either removed (PRK) or intersected (LASIK), it is possible that in
the long run patients who underwent refractive surgery may be
confronted with optical problems.
© 2001 by British Journal of Ophthalmology
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