糖尿病患者角膜内皮细胞的内皮显微镜观察

使用接触型角膜内皮显微镜摄像观察了糖尿病患者６０只眼内皮细胞形态学的变化。结果表明：糖尿病患者角膜内皮细胞的密度与正常人同年龄组比较，差异无显著性；内皮细胞非六边形的比率，患者组较正常同年龄组明显升高。说明细胞构型紊乱很可能是糖尿病患者内皮细胞功能异常的病理学基础。     

共焦显微镜下虹膜角膜内皮综合征的角膜形态学观察

目的 观察共焦显微镜下虹膜角膜内皮综合征(ICE)的角膜各层组织的形态学特点.方法 观察型系列病例研究.对2000年1月至2007年6月在复旦大学附属眼耳鼻喉科医院眼科就诊的23例(23只眼)ICE患者,行共焦显微镜(NIDEK,Confoscan 3.0)下双眼检查.使用NAVIS软件记录和分析角膜各层组织图像,并使用SPSS 13.0软件对患眼的角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例及有核细胞比例进行单因素方差分析.结果 ICE患眼的角膜内皮细胞呈"风筝样"或"上皮细胞样",细胞形态失去正常的六角形外观,细胞排列紊乱,胞内可见高反光的细胞核,部分细胞内可见双核或细胞分裂象.随病程时间延长,患眼角膜内皮细胞密度和六角形细胞比例逐渐下降.病程短于1年、1～3年、3～5年及超过5年患者的角膜内皮细胞密度分别为(1687.1±122.6)、(1210.6±168.7)、(947.3±145.2)及(856.8±73.4)个/mm2;六角形细胞比例分别为(51.5±6.3)%、(39.8±9.2)%、(32.7±8.1)%及(24.1±5.6)%.随病程时间延长,患眼角膜内皮细胞平均面积和有核内皮细胞比例逐渐升高.病程短于1年、1～3年、3～5年及超过5年患者的内皮细胞平均面积分别为(678.3±56.3)、(928.7±96.2)、(1188.5±72.6)及(1337.5±60.8)μm2;有核细胞比例分别为(12.6±1.4)%、(56.8±3.7)%、(78.7±5.6)%及(84.3±2.8)%(F=7.158,7.736,6.876,14.452;均P=0.000).患眼基质细胞形态无异常,但是随病程延长,基质神经纤维逐渐增粗并明显扭曲.患眼上皮细胞的形态无异常.对侧眼角膜的各层形态结构无明显异常.结论 共焦显微镜下ICE患眼的角膜内皮细胞表现有一定特点,共焦显微镜对于判断ICE的病程进展有诊断价值.     

100例儿童角膜内皮细胞分析

目的：观察４～１０岁儿童中央区角膜内皮细胞密度及形态学特征。方法：应用非接触型角膜内皮显微镜进行观察。结果：儿童中央区角膜内皮细胞平均密度及六角形细胞百分率明显高于成年人（Ｐ＜０．０１）,平均细胞面积明显小于成年人（Ｐ＜０．０１）;远视性屈光不正儿童内皮细胞平均密度高于非远视者（０．０１＜Ｐ＜０．０５）。结论：儿童角膜内皮细胞在正常人群中平均密度最高、形态最佳,并具有最大的自身扩潜能力;随着年龄增长,角膜内皮细胞将发生一系列规律性变化。     

共焦显微镜观察虹膜角膜内皮综合征及其继发性青光眼的手术治疗

目的应用共焦显微镜检查探讨虹膜角膜内皮综合征的临床特征及其继发性青光眼的手术治疗。方法 8例（8眼）虹膜角膜内皮综合征行共焦显微镜下双眼检查;描述角膜内皮的病变结构特点,分析双眼角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例及中央角膜厚度,并对6例继发性青光眼中的5例施行手术治疗。结果患眼角膜内皮细胞呈风筝样或上皮细胞样改变;细胞排列紊乱,大小不均;细胞内可见高反光的细胞核,部分可见双核。患眼和对侧眼的角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例分别为：789.7±75.8个/mm^2、2223.7±80.6个/mm^2;1106.9±89.4μm^2、379.8±20.6μm^2;17.2±1.2%、56.3±1.7%,下降明显。二者的中央角膜厚度相当。4例继发性青光眼手术后眼压控制正常,另1例手术无效。结论共焦显微镜能够发现ICE患者的角膜内皮细胞的特征性改变;对该病的诊断具有很高的临床意义。并发继发性青光眼要及时手术治疗控制眼压。     

共焦显微镜在不典型虹膜角膜内皮综合征诊断中应用

目的 探讨共焦显微镜检查在虹膜角膜内皮综合征临床诊断中的应用价值.方法 对8例(其中6例单眼患病,2例双眼患病)常规检查无法确诊的疑似虹膜角膜内皮综合征病例进行共焦显微镜检查.观察角膜内皮层病变结构.结果 活体共焦显微镜检查发现患眼角膜内皮细胞均偏大而且形状不规则,细胞核反光明显增高,可见散在双核、多核、偏位核及分叶核等改变,7例细胞边界模糊,部分病例有局灶内皮细胞缺失、胞内环形暗区、分裂状细胞等改变.此外,3例单眼患病病例的对侧眼在共焦显微镜下发现内皮细胞密度下降、大小不均等改变.最后确诊为原发性进行性虹膜萎缩型2例、Chandler综合征4例、Cogan-Reese综合征2例.结论 共焦显微镜可以在细胞水平上无创、高分辨率地观察到虹膜角膜内皮综合征患眼角膜内皮层特征性的显微结构改变,且不受角膜水肿的影响,大大提高了虹膜角膜内皮综合征诊断的准确性,并有助于早期诊断,具有很高的应用价值.     

应用共焦显微镜观察Fuch角膜内皮营养不良患者的病变形态学特征

目的探讨应用共焦显微镜观察我国Fuch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19例(38只眼)Fuch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,分为有症状组(19只眼)和无症状组(19只眼),并选取30只眼作为正常对照组,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:19只眼的角膜内皮层均见到滴状赘疣,直径20-60 μm,内皮细胞密度与正常对照组比较差异有显著意义(t=18.74,P<0.01);9只眼后弹力膜增厚;14只眼角膜后基质层有长条形暗区结构;19只眼角膜基质反光普遍增强;17只眼Bowman膜有局灶性高反光区域;19只眼基底上皮细胞形态大致正常;10只眼显示正常的角膜神经结构;后、前基质细胞密度,与正常对照组比较差异无显著意义(t=0.854、1.173,P=0.38、0.24)。(2)无症状组:19只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,与正常对照组比较,差异无显著意义(t=1.998,P=0.053);角膜其余各层未见异常。有症状组与无症状组的内皮细胞密度计数比较,差异有非常显著意义(t=8.352,P<0.01)。结论活体共焦显微镜检查有助于Fuch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。(     

原发性青光眼患者角膜内皮形态研究

目的研究角膜内皮细胞在各种原发性青光眼患者中的形态改变及临床意义。方法选择住院青光眼患者34例52眼及同期住院患者中的正常眼32眼作为对照,采用非接触型角膜内皮显微镜测量角膜内皮细胞密度和细胞面积等各项指标,用Goldman压平式眼压计测量眼压并用超声角膜测厚仪测量角膜中央厚度;分析比较不同类型青光眼患者角膜内皮细胞各项测量指标及角膜中央厚度的差异。结果急性闭角型青光眼有急性发作史者角膜内皮细胞密度为(2060±314)个·mm-2,显著低于正常人的(2876±341)个·mm-2,并且细胞面积增大(P<0.05);慢性闭角型青光眼平均角膜内皮细胞密度为(2806±253)个·mm-2,原发性开角型青光眼组角膜内皮细胞密度为(2704±430)个·mm-2,二者均与正常人的内皮细胞平均密度之间差异无统计学意义(P>005)。急性闭角型青光眼急性发作后角膜中央厚度平均为569.7μm,明显大于正常人的536.0μm;而慢性闭角型青光眼组角膜中央厚度平均为541.0μm,原发性开角型青光眼组为540.7μm,二者均与正常对照组无明显差异(P>0.05)。结论闭角型青光眼急性发作后角膜内皮细胞密度显著低于正常人,细胞平均面积增大,角膜中央厚度明显增加;慢性闭角型青光眼和原发性开角型青光眼患者角膜内皮及角膜中央厚度均与正常对照无明显差异。     

原发性青光眼患者角膜内皮形态研究

目的研究原发性青光眼角膜内皮形态改变。方法住院原发性青光眼56例(89只眼),按诊断标准分为急性原发性闭角型青光眼(aPACG)、慢性原发性闭角型青光眼(cPACG)、原发性开角型青光眼(POAG)3组,同期住院白内障和正常人40例(40只眼)作为对照组。4组均用角膜内皮细胞计检查并用配套的计算机辅助测量分析系统对图象处理分析,指标有单位面积细胞密度、最小细胞面积、最大细胞面积、平均细胞面积、平均细胞面积的标准差、细胞面积的变异系数和六角形细胞所占比例。全部资料用社会科学统计软件包(SPSS)进行统计学分析。结果单位面积细胞密度对照组为(2876.32±257.85)cells.mm-2,显著高于原发性青光眼组。aPACG:(2607.36±431.97)cells.mm-2,P=0.041;cPACG:(2582.42±379.89)cells.mm-2,P=0.001;POAG:(2637.69±342.60)cells.mm-2,P=0.028。慢性原发性闭角型青光眼组的最大细胞面积、平均细胞面积、细胞面积的标准差均高于对照组(MAXP=0.005,AVEP=0.025,SDP=0.031)。结论原发性青光眼患者角膜内皮单位面积细胞密度明显低于正常人,差异有统计学意义;慢性原发性闭角型青光眼组的最大细胞面积、平均细胞面积、细胞面积的标准差均高于正常人组,差异有统计学意义。     

HAI EB-3000XYZ型眼库内皮显微镜对供体角膜内皮的评估

目的 评价HAI EB-3000XYZ型眼库内皮显微镜对供体角膜内皮细胞检测的可靠性。方法 选取供体角膜材料35例,年龄11～50岁;按供体死亡时间分为3组:A组≤6h;B组7～12h;C组>12h。术前分别对3组行内皮显微镜检查,PKP术后对剩余角膜环行台盼蓝-茜素红联合染色。对两者所测得的内皮细胞密度进行比较;对内皮显微镜测得的内皮细胞六边形比例和染色测得的活性率行相关分析。结果 在A、B两组中,内皮显微镜检测得的内皮细胞密度与染色结果无明显差别;C组两者之间的差别有显著统计学意义(P=0.000)。3组的内皮细胞六边形比例与活性率之间均没有明显的相关性。结论 HAI EB-3000XYZ型眼库内皮显微镜对死亡时间在12h以内的供体角膜内皮细胞密度检测较为准确,而对死亡12h以上的供体材料的检测则存在一定误差。     

乳化硅油滴在活体角膜内皮的共焦显微镜表现

目的 采用角膜激光共焦显微镜观察乳化硅油滴在活体角膜内皮面的形态,比较并总结其特点.方法 应用自身对照研究.对近年来在深圳市眼科医院就诊的20例(20只眼)临床硅油乳化的患者采用激光角膜共焦显微镜检查其角膜,分析研究其图像特点,总结乳化硅油滴在活体角膜内皮的共焦显微镜表现.结果 乳化硅油滴在角膜内皮面有着不同的大小和排列方式,镶嵌于角膜内皮面,并伴有角膜内皮细胞的明显水肿增大,内皮细胞的结构不清,仅有模糊轮廓.结论 采用新型的激光角膜共焦显微镜可以观察到乳化硅油滴对角膜内皮细胞的直接损害.该检查是一种对人体无害、可以反复进行,并且连续观察角膜内皮变化的工具,对评估乳化硅油滴对角膜的损害具有重要作用.

Abstract：

Objective To study the emulsified silicone oil droplets in the corneal endothelium by in vivo laser confocal microscopy, compare and summarize its characteristics. Methods The corneas of 20 patients (20 eyes) with silicone oil emulsion were examined by in vivo laser confocal microscopy, analyzed the characteristics of the images, and summarized the performance of emulsified silicone oil droplets in corneal endothelium with confocal microscopy. Results Emulsified silicone oil droplets in the corneal endothelium had a different size and arrangement, embedded in the corneal endothelium and come al endothelial cells associated with increased edema; endothelial cell structure was unclear, with only vague outlines. Conlulusions New type of laser corneal confocal microscope can observe the corneal endothelium damage by emulsified silicone oil drops directly. The inspection is a harmless, can be repeated and continuous observation of corneal endothelial changes in the tools. The laser corneal confocal microscope plays an important role on the assessment of silicon emulsion oil droplets on the cornea in the damage.     

用镜面反射显微镜对正常人不同年龄组角膜内皮细胞的观察

应用非接触型内皮显微镜对正常人204只眼角膜内皮细胞进行观察。结果表明:正常人角膜内皮细胞平均密度随年龄增大而减少;平均面积随年龄增大而增大;男女内皮细胞和左右眼内皮细胞无明显差异;内皮细胞形态学变化是年龄越大,多形性越明显,黑区出现率越高。角膜的透明性与其内皮细胞的结构和功能有密切关系,术前了解内皮细胞状况,有助于减少大泡性角膜病变的发生。本文研究结果与近来国内外研究结果基本一致。     

非接触式角膜内皮镜测量正常角膜厚度的研究

目的:采用非接触式角膜内皮镜测量正常人的中央角膜厚度(Central corneal thickness,CCT),并探讨其相关影响因素。方法:采用KONAN非接触式角膜内皮镜测量173例(322只眼)正常眼的中央角膜厚度(CCT),得出正常值范围。同时测量距离角膜正中央3mm处的旁中心角膜厚度(12点、2点、10点、6点方位),并进行角膜内皮细胞检查。所有资料输入计算机后在Windows操作环境下使用SPSS10.0统计软件进行统计分析。结果:非接触式角膜内皮镜测得的正常眼CCT平均值为(554.78 32.61)μm,与性别、眼别无明显相关性,与年龄、角膜内皮细胞密度与平均细胞面积呈非线性相关。距离角膜正中央3mm处,12点方位角膜最厚,6点方位角膜较薄,但均厚于CCT。结论:非接触式角膜内皮镜能准确地测量中央角膜厚度,结果可靠。     

Morphometric analysis of the corneal endothelium with three different specular microscopes

The morphometry of the central corneal endothelium of 10 eyes in 10 subjects was analyzed with three different specular microscopes. Computer-assisted analysis was performed with only two microscopes (Zeiss and Keeler Konan sp 3300) because the third microscope (Topcon sp 1000) could not be adapted to our computerized system. With this Topcon microscope a grid with standard densities was used to compare the images with, in addition, we also performed manual cell counting on the same Topcon images. The coefficient of variation of the cell analysis of three different images per cornea with the four methods varied between 3.4 and 4.7 percent. One-way analysis of variance showed a significant difference between the Zeiss and the other microscopes. So only the Keeler Konan and the Topcon microscopes could be used interchangeably. The computerized image analysis permitted also an evaluation of the hexagonality. The results of polygonality were not significantly different between the Zeiss and the Keeler Konan. For clinical purposes the Topcon specular microscope is more advantageous than the other two methods, since it is the most rapid way to record and analyze specular images. But for more precise measurements an image processing system is indispensable.None of the authors have proprietary interest in the equipment described.     

Clinical Investigations on the Corneal Endothelium

The normal level of the corneal thickness and hydration is maintained by the barrier function and active fluid pump of the corneal endothelium. Three methods are currently available for the clinical study of this cell layer: (1) endothelial dysfunction results in a corneal swelling, and measurement of the corneal thickness allows the degree of endothelial damage and its repair processes to be evaluated; (2) the state of the barrier function may be studied through determination of the endothelial permeability to fluorescein; and (3) the endothelium can be photographed by specular microscopy, and the cell density and cell size distribution can be studied by morphometric analyses. A follow-up study of the cell transformation after surgical trauma revealed that the human endothelium shows very little proliferative activity, and the damaged area is covered by migration of cells in the surrounding area. It appears that the traumatized endothelium loses cells at a faster rate than that seen in the normal aging process, and endothelial dysfunction may develop many years after injury.     

Wide Field Specular Microscopy: Clinical and Research Applications

Through the use of a scanning mirror system, the field of view has been expanded to as much as 0.9 mm in diameter. Both contact and non-contact specular microscopy are possible, each having advantages. In a research application, wound healing in rabbit endothelium is documented by time lapse photography. The study demonstrates the capability to return to an area of interest provided there is a landmark. Clinical applications and advantages over conventional specular microscopy are discussed.     

湿房和深低温保存角膜穿透性移植术后角膜内皮分析

目的　探讨深低温长期保存和短期湿房保存角膜移植术后植片角膜内皮细胞形态学特征。方法　应用深低温长期保存 30～ 5 0个月 (平均 2 5 .0± 11.9个月 )青壮年供体眼角膜完成穿透性角膜移植 2 4例 (2 4只眼 ) ,同时与来自于青壮年供体经 4℃湿房保存的新鲜供眼角膜穿透性移植术后的角膜内皮细胞状况相比较。全部患者术后角膜植片保持透明 ,未曾出现移植免疫排斥反应 ,手术操作由同一医生完成。术后 2～ 2 0 (平均 6 .7± 3.1)个月应用接触式角膜内皮显微镜及与其同步显示的角膜内皮细胞分析仪对角膜植片中央内皮细胞进行观察和分析。结果　应用深低温保存和湿房保存角膜行穿透性角膜移植术后角膜内皮细胞平均面积、细胞平均密度、面积变异系数、细胞最大面积、细胞最小面积以及六角形细胞出现率间均无显著性差异 (t=0 .116～ 1.195 ,P >0 .0 5 )。结论　应用深低温保存角膜和湿房保存角膜行穿透性角膜移植术后角膜内皮细胞具有相同的临床价值     

深低温长期保存角膜穿透移植术后角膜内皮分析

目的 :了解深低温长期保存角膜移植术后植片内皮细胞的情况。方法 :应用深低温长期保存 3 0天～ 5 0个月 (平均 2 5 0± 11 9个月 )青壮年供体眼角膜完成穿透性角膜移植 2 4例 (2 4眼 )。供眼角膜深低温保存采用Kaufman Capella冷冻保存及复温技术。全部患者角膜植片一直保持透明 ,术后未曾出现移植免疫排斥反应 ,手术操作均由同一医生完成。术后 2～ 13 (平均 5 5± 2 2 )个月 ,应用接触式角膜内皮显微镜及与其同步显示的角膜内皮细胞分析仪对角膜植片中央进行观察和分析。结果 :角膜植片平均内皮细胞密度达 1769 6± 493 7个 /mm ,变异系数为 3 1 3± 11 4% ,六角形细胞出现率为 5 9 0± 6 9% ;植片内皮细胞密度与供体年龄、细胞面积变异系数呈负相关 ,与深低温保存时间以及受体年龄无关 ;六角形细胞出现率与植片内皮细胞密度呈正相关 ,与面积变异系数呈负相关 ,与术后随访时间无相关性。结论 :深低温长期保存角膜可满足穿透性角膜移植的需要。     

Changes in Corneal Thickness and Specular Microscopic Indices in Acute Unilateral Anterior Uveitis

Purpose: To compare central corneal thickness (CCT) and specular microscopic indices in active unilateral anterior uveitis with the same indices 1 week after the initiation of treatment. Methods: This study included 30 eyes with active unilateral idiopathic anterior uveitis. CCT and specular microscopic indices were compared before and after 1 week of the treatment with topical medications.

Results: At the first visit, mean CCT was significantly greater in affected eyes (mean?±?standard deviation: 514.0?±?23.0) than in fellow eyes (493.2?±?10.6) (p?p?Conclusion: We found that eyes with unilateral active anterior uveitis had increased CCT in comparison to their healthy fellow eyes without a change in the specular microscopic indices.     

Color Specular Microscopy of Disorders Involving the Corneal Epithelium

Color specular microscopy, a noninvasive, in vivo microscopic technique, was utilized to study the corneal epithelium in 17 patients including eight with keratoconus, seven with bullous keratopathy, and two with Fuchs' corneal dystrophy. Color specular microscopy was also performed on rabbit corneas with experimental surgical trauma. Changes observed by specular microscopy in these diseased states correlated with alterations noted by light microscopy and scanning and transmission electron microscopy. Specular microscopy can provide detailed in vivo cellular morphology of the ocular surface, obviating the need for tissue biopsy. Thus, specular microscopy is a valuable diagnostic technique available for the clinician to monitor changes of the diseased ocular surface.     

In Vivo Specular Microscopy of Edematous Human Corneal Epithelium with Light and Scanning Electron Microscopic Correlation

A wide-field contact specular microscope was used to examine and to photograph the corneal epithelium in 35 eyes with chronic corneal edema. Seven of the patients subsequently underwent corneal transplantation allowing for correlation of the in vivo findings with the light and electron microscopic appearance. The early findings on specular microscopy included loss of the clear superficial epithelial cell outlines with easy dislodgement of these cells and a fine pattern of edema outlining basal cells. Individual cellular edema and fluid-filled cysts occurring at various epithelial layers and subepithelially appeared with worsening swelling. Subepithelial connective tissue and anamalous basement membrane were present at later stages.