圆锥角膜行去上皮角膜胶原交联术后角膜微结构的变化

目的：采用共焦显微镜观察进展期圆锥角膜行去上皮角膜胶原交联术后角膜微结构的变化。

方法：选取2016-02/2017-02于我院行上皮角膜胶原交联术治疗的进展期圆锥角膜患者11例15眼，分别于手术前后行共焦显微镜检查，观察角膜微结构变化。

结果：术后早期角膜上皮下神经纤维显著减少或消失； 角膜前基质呈蜂窝状，几乎无典型的角膜基质细胞，术后3mo基质细胞开始出现，术后12mo基质细胞数量几乎恢复到术前水平，但角膜上皮下神经仍稀疏，未达到术前水平； 术后后部角膜基质细胞和内皮细胞大小及形态未受影响。

结论：角膜胶原交联术后角膜微结构发生变化最明显的是上皮下神经纤维和前基质细胞，但随着随诊时间的延长，这种变化呈逐渐减弱趋势。

Results of confocal microscopy examinations after epithelium-off collagen cross-linking in patients with keratoconus

AIM: To analyze microstructural changes, after epithelium-off corneal collagen cross-linking for progressive keratoconus by using in vivo confocal microscopy(IVCM).

METHODS: Totally 15 eyes in 15 patients with progressive keratoconus were treated by the photochemical epithelium-off cross-linking method. Patients were examined pre- and postoperatively by confocal in vivo laser scanning microscopy.

RESULTS: The sub-basal nerve significantly decreased or disappeared and the anterior corneal stroma had a honeycombed appearance but without the typical hy-perreflective keratocyte nuclei after early stage of treatment. At 3mo postoperatively, the corneal stroma had a small amount of the typical hy-perreflective keratocyte nuclei. After 12mo,the corneal stroma almost recovered to the preoperative level, but the sub-basal nerve were still sparse and didn''t reach the preoperative level. The endothelial cells showed no significant reduction during the follow-up.

CONCLUSION: This IVCM study revealed loss of the sub-basal nerve plexus and loss of anterior stromal keratocytes in the early postoperative period, with regeneration of keratocyte repopulation by 12mo postoperatively, but the sub-basal nerve plexus didn''t reach the preoperative level.