颗粒状角膜营养不良活体共焦显微镜形态学研究

目的研究颗粒状角膜营养不良角膜各层组织的共焦显微镜形态改变。方法应用Confoscan2.0共焦显微镜对13例(26眼)颗粒状角膜营养不良患者的角膜进行扫描检查,记录与分析各层角膜图像。结果所有患眼前基质细胞及16/26眼后基质细胞结构不清,排列紊乱,并可见短棒状多形性强反光;6/26眼前弹力层不规则并增厚,神经纤维密度明显下降;6/26眼角膜上皮基底细胞层可见不定型的强反光;2/26眼角膜上皮细胞边界不清,排列呈疏松的蜂窝状,并出现不透明的强反光;所有患者角膜内皮细胞形态基本正常。视力0.3以下的患眼角膜上皮细胞层、上皮基底细胞层、前弹力层、后基质层发生形态异常的比例高于0.3以上的患眼(P<0.05)。结论1.共焦显微镜可活体检查颗粒状角膜营养不良角膜组织各层结构,起到类似病理组织切片的作用。2.前基质层形态异常可能是颗粒状角膜营养不良最基本的共焦显微镜形态特征,病情越重,前基质层以外的其它层次发生形态异常的可能性越大,但内皮细胞层一般不受累。3.共焦显微镜检查对颗粒状角膜营养不良手术方式的选择具有一定的参考价值。

Corneal morphology in granular dystrophy by confocal microscopy in vivo

Objective To describe the corneal morphological abnormalities in corneal granular dystrophy by confocal 2.0 microscopy. Methods Twenty-six eyes of 13 patients were examined by confocal microscopy in vivo. Results In 2 of the 26 examined corneas the surface epithelium appeared abnormal. 6 corneas the basal epithelial cells was characterized by irregular light patches. In 6 eyes Bowman's layer was irregular and thicker, in general, the number of long nerve fiber bundles in these eyes was reduced compared with control corneas. All corneas showed abnormal and illegibility keratocyte appearance in the anterior stroma, 16 posterior stroma keratocytes showed like the anterior stroma, and many irregular hyperreflective like cosh could be seen in stroma layer. All corneas the endothelium was normal. Conclusions 1.Confocal scanning microscopy is a good tool for the study of cellular morphology of granular corneal dystrophy. 2. Abnormal morphology in the anterior stroma is perhaps the basic change. The vision is more lower, abnormal morphology can more be seen in other layers except anterior stroma layer, however, no abnormal morphology can be seen in the endothelium layer. 3. Confocal scanning microscopy can help choose more appropriate operation to treat granular corneal dystrophy.