糖尿病患者角膜知觉测定和共焦显微镜观察

目的探讨糖尿病患者角膜知觉、共焦显微镜下角膜全层细胞和神经纤维的变化。方法观察2002年3至9月份期间于我院内分泌科住院和门诊确诊的132例（264只眼）糖尿病患者,记录糖尿病病史和糖尿病用药情况,监测患者空腹血糖和糖化血红蛋白（HbA1c）水平。眼科检测包括视力、眼压、角膜知觉、晶状体和眼底。并与同期在我院眼科门诊就诊的200例（400只眼）非糖尿病患者对照。对其中85例糖尿病患者和56例对照者进行共焦显微镜角膜上皮、上皮下神经纤维、前后基质、内皮细胞形态和计数检查。结果糖尿病患者角膜知觉较对照组明显减退（P〈0．01）。糖尿病患者角膜知觉与年龄、糖尿病的病程、有无糖尿病视网膜病变及病变的程度呈负相关关系;共焦显微镜检查显示,糖尿病组角膜上皮水肿率（11．76％）高于对照组（1．79％）（P〈0、05）;角膜神经丛的密度低于对照组（P〈0．01）;糖尿病患者角膜神经纤维纤细,分支减少,粗细不均,部分角膜神经末梢水肿,走行弯曲。结论糖尿病患者的角膜知觉减退、角膜上皮病变的发生可能与神经纤维数目的减少和变性有关。（中华眼科杂志,2005,41：920-923）

In vivo confocal microscopy observation and evaluation of sensation in diabetic corneas

OBJECTIVE: To test the changes of corneal sensation in diabetic patients and to observe the diabetic corneas using confocal microscopy. METHODS: One hundred and thirty-two diabetic patients were enrolled in this study. The diabetic history and medication were recorded. The FBG and HbA(1c) were checked for every patient. The patient's eye was systemically checked, including the IOP, visual acuity, cornea sensation, lenses, and the fundus. Two hundred patients of other diseases were enrolled as controls. The cornea of 85 patients and 56 controls were checked by the confocal microscopy. The right eyes of both patients and controls were used for analysis. RESULTS: The cornea sensation of diabetic patients was significantly depressed as compared to that of the controls (P < 0.01). The depression of cornea sensation was related to the course of the disease, the presence of diabetic retinopathy and the degree of the diabetic retinopathy (P < 0.05). The confocal microscopy revealed that there was a higher corneal epithelium edema rate (11.76%) in diabetic patients than that of the controls (1.79%) (P < 0.05). The nerve fiber density of the diabetic patients was decreased and there were some morphological changes in the nerve fiber of diabetic patients, such as sparse, slim, less branches, less long fibers, edema and zigzag of the fibers. CONCLUSION: The depression of the corneal sensation in diabetic patients is probably caused by the reduction and the degeneration of the corneal nerve fibers.