共焦显微镜在角膜病变中应用的新进展

共焦显微镜(confocal microscopy, CM)检查作为一种“活体组织学检查”方法,以其实时、无创、快速、高清的特点,在角膜生理、病理研究及疾病诊断、病情评估、随访等方面显示出优越性,已在眼科临床及科研中得到广泛应用。本文将对CM在感染性角膜疾病、变性性角膜疾病及全身疾病所致角膜病变中应用的新进展作一综述。     

强脉冲光联合睑板腺按摩治疗睑板腺功能障碍的短期疗效

目的：评估强脉冲光（IPL）联合睑板腺按摩（MGX）（IPL/MGX）治疗睑板腺功能障碍（MGD）的短期 疗效。方法：前瞻性临床研究。选择2016年11月至2017年12月于汉口爱尔眼科医院门诊连续就诊 的MGD患者55例,最终完成随访的有48例（96眼）,双眼均行IPL/MGX治疗,每3周治疗1次,共3次。 在治疗前、治疗结束后1周进行眼表疾病指数（OSDI）问卷调查、泪膜破裂时间、角膜染色、睑板腺 功能及成像、结膜眼红评分、共聚焦显微镜下睑板腺及蠕形螨检查等。使用配对t检验、Wilcoxon 秩和检验及Spearman秩相关分析对数据进行处理。结果：IPL/MGX治疗结束后1周与治疗前比较, OSDI评分降低（t=2.300,P=0.024）,睑板腺分泌能力与睑酯质量均得到改善（Z=-3.617,P<0.001;t= 2.472,P=0.017）,角膜染色评分、球结膜眼红评分降低（Z=-2.757,P=0.006;t=2.040,P=0.044）,睑 板腺腺周炎症细胞密度下降（t=4.765,P<0.001）,睫毛根部蠕形螨总数减少（t=2.121,P=0.037）。睑 板腺萎缩面积<50%的MGD患者,治疗后症状评分、眼表炎症状态及睑板腺功能显著改善,睑板腺 萎缩面积≥70%的MGD患者,治疗前后各项指标均未见明显改善。结论：IPL/MGX可明显改善睑板 腺萎缩程度尚轻的MGD患者主观症状及睑板腺功能,减轻患者眼表炎症,减少眼蠕形螨数量,降低 眼表损害。     

Corneal esthesiometry and sub-basal nerves morphological changes in herpes simplex virus keratitis/uveitis patients

AIM: To describe and compare corneal sensation and morphological changes of sub-basal corneal nerves by in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis/uveitis and contralateral, clinically unaffected eyes. METHODS: A prospective clinical study included 30 HSV eyes and 30 contralateral eyes of 30 patients, diagnosed with unilateral HSV keratitis/uveitis. Both eyes underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6mo, the same examination of the HSV affected and contralateral, clinically unaffected eyes was performed. RESULTS: HSV eyes, as compared to contralateral eyes, demonstrated a significant decrease in mean corneal sensation (3.1±1.6 vs 5.3±0.8 cm), total nerve fibres number (5.7±4.4 vs 15.1±5.4), nerve branches (3.4±3.0 vs 8.4±4.7), main nerve trunks (2.3±1.6 vs 5.8±2.2), and nerve fibres density (7.5±5.6 vs 18.1±5.3 mm/mm2, P<0.05). There was no significant difference between keratitis and uveitis eyes in mean corneal sensation and nerve fibres parameters. After 6mo, corneal sensation and sub-basal nerve fibres parameters were increased significantly, but did not reach the parameters of contralateral, clinically unaffected eyes. CONCLUSION: Corneal aesthesiometry and LSCM in HSV affected eyes reveals a significant decrease of corneal sensation and sub-basal nerve fibres which recovers at 6mo but does not reach the normal level.     

Development of Conductive Boron-Doped Diamond Electrode: A microscopic,Spectroscopic, and Voltammetric Study

Building on diamond characteristics such as hardness, chemical inertness and low electron emission threshold voltage, the current microscopic, spectroscopic and voltammetric investigations are directed towards improving the properties of electrode coating materials for their future use in clinical studies of deep brain stimulation via fast-scan cyclic voltammetry (FSCV). In this study we combine the capabilities of confocal Raman mapping in providing detailed and accurate analysis of local distributions of material constituents in a series of boron-doped polycrystalline diamond films grown by chemical vapor deposition, with information from the more conventional techniques of scanning electron microscopy (SEM) and infrared absorption spectroscopy. Although SEM images show a uniform distribution of film crystallites, they have the limitation of being unable to differentiate the distribution of boron in the diamond. Values of 10¹⁸–10²¹ atoms/cm³ of boron content have been estimated from the absorption coefficient of the 1290 cm⁻¹ infrared absorption band and from the 500 cm⁻¹ Raman vibration. The observed accumulation of boron atoms and carbon sp² impurities at the grain boundaries suggests that very high doping levels do not necessarily contribute to improvement of the material’s conductivity, corroborating with voltammetric data. FSCV results also indicate an enhanced stability of analyte detection.