Fuchs角膜内皮营养不良患者的共焦显微镜特征

目的：探讨共焦显微镜下Fuchs角膜内皮营养不良患者角膜各层的活体形态学特征。方法：对16眼Fuchs角膜内皮营养不良患者的中央部角膜进行活体共焦显微镜检查,应用NAVIS软件测量、分析角膜各层组织细胞形态和密度、以及滴状赘疣和角膜神经的直径。结果：①有症状组：9眼的角膜内皮层均见到滴状赘疣,直径20～60μm,内皮细胞密度低;4眼后弹力膜增厚;6眼角膜后基质层有长条形暗区结构;9眼角膜基质反光普遍增强;7眼Bowman膜有局灶性高反光区域;5眼显示正常的角膜神经结构;②无症状组：7眼的角膜内皮层均见到滴状赘疣,数目较有症状组者少,直径15～40μm;内皮细胞密度正常;角膜其余各层未见异常。结论：本研究初步揭示了Fuchs内皮营养不良患者共焦显微镜下的形态学特征;活体共焦显微镜检查有助于Fuchs角膜内皮营养不良患者的诊断,特别适用于角膜水肿、角膜内皮镜无法成像的患者。

Morphologic Characteristics of Cornea in Fuchs Endothelial Dystrophy Observed by Confocal Microscopy

Objective：To analyze the image of corneas with Fuch’s endothelial dystrophy using confocal microscopy.Method：Central corneas of 16 eyes were examined using scanning slit confocal microscopy in vivo after being diagnosed with Fuchs endothelial dystrophy.The images were analyzed visually for morphology of corneas and the densities of cells,as well as the diameter of the guttae and the corneal nerves were cuntered by NAVIS software.Result：①In the symptomatic groups,confocal microscopy revealed guttae in 9 eyes.The diameter of the guttae ranged from 20 to 60μm.The density of endothelial cells was low.Descemet’s membrane was thickened in 4 eyes.Dark bands were detected in 6 eyes.All eyes showed a diffuse increased light reflection in the stroma.7 eyes exhibited an abnormal Bowman’s layer：multiple focal bright reflection.5 eyes revealed normal corneal nerves.② In the asymptomatic groups less number of guttae could be seen in the endothelial layer.The diameter of the guttae was 15～40μm.The densities of endothelial cells were normal.Other layers of the cornea no any other abnormal phenomenon.Conclusion：Morphologic characteristics of cornea were observed by confocal microscopy.Confocal microscopy allows to diagnose Fuchs dystrophy and visualize endothelial cells within the swollen cornea.And it is especially useful for patients whose endothelial cells can not be seen with non-contact sepcualr microscopy.