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. 2021 Oct 28;24:101224. doi: 10.1016/j.ajoc.2021.101224

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© 2021 The Authors

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

PMC Copyright notice

Fig. 1 — Histopathology of corneal buttons after corneal perforation in ocular graft-versus-host disease and clinical photograph of healed corneal perforation.

Representative histopathology is presented for the acute phase of corneal perforation in case 3 (A) and the healed phase in case 6 (B–

E).

A: The wide acute perforation site (p) is evident, partially filled with a mixture of chronic inflammatory cells, granulation tissue, and heme (block arrows), and with iris tissue (i) and pars plana (pp) prolapsing toward the perforation site. Adjacent to the perforation, calcific keratopathy is seen (Ca), along with anterior stromal vascularization associated with minimal inflammatory cells (arrow within magnified inset) (hematoxylin and eosin [H&E] stain, original magnification, ×20).

B: At low magnification, the healed perforation site (p) is identified by a narrow gap in the stroma. Anterior to mid-stromal vascularization (v) is appreciated peripherally to mid-peripherally (H&E stain, original magnification, ×40).

C: With periodic acid-Schiff (PAS) stain at higher magnification, the full width of the antecedent perforation site is identified by the broken ends of Descemet's membrane (d) paracentrally, and an additional break in Descemet's is also seen beyond the main perforation (arrow). A fibrous retrocorneal membrane (f) is appreciated, relatively thinner at the edges of the prior perforation, but centrally becoming so thick as to essentially replace the full thickness of the stroma. Foci of melanin pigment are evident within the fibrous membrane, presumably iris-derived (original magnification, ×100).

D, E: Immunostaining confirms the replacement of the central stroma by the fibrous retrocorneal membrane. In (D), CD34 immunostain (marker of normal keratocytes) exhibits positivity only peripheral to the central region, whereas in (E), smooth muscle actin immunostain (for myofibroblasts) exhibits full-thickness positivity in the central zone, confirming that the central portion of the stroma has been replaced with fibroconnective scar tissue (original magnification, ×40).

F: Representative clinical photograph of healed corneal perforation showing stromal neovascularization and opaque scarring, approximately 5 months after corneal gluing for acute perforation in case 5.