圆锥角膜患者表面角膜镜片术后镜片细胞和神经重建的活体动态观察

目的：应用共焦显微镜观察圆锥角膜患者表面角膜镜片术（epikeratophakia,EP)后不同时期的镜片组织,了解低温冷冻脱水角膜材料移植后组织细胞和神经重建的动态过程。方法：对24例（24只眼）圆锥角膜患者行EP,应用共焦显微镜分别对术后不同时期的角膜镜片组织细胞、神经重建过程进行活体动态观察,并摄像记录。结果：镜片上皮层：术后3或4d,组织镜片表面已被角膜表层上皮细胞覆盖,镜片边缘可见翼状细胞及形态不规则、低密度的基底细胞;术后1个月,上皮基底细胞完全覆盖角膜镜片;术后6个月,基底细胞密度及形态趋于正常,可见上皮下散在神经丛;术后2年,神经丛形态接近正常。镜片基质层：术后1年内,镜片基质细胞无变化,细胞少、形态不规则;术后2年,镜片边缘偶见正常形态的基质细胞;术后5年,镜片中央仍未见正常形态的基质细胞,镜片前后基质细胞相同。镜片基质神经：术后6个月,有神经干伸入镜片基质内,术后2年,基质神经数量增多;术后5年,基质神经尚未达到正常密度。结果：冷冻的非活性角膜组织行EP后组织镜片各层细胞、神经重建的时间各不相同,但并不影响植片透明度。

Observation on healing process of corneal lens after epikeratophakia with confocal microscopy

Objective To investigate the nerve and cell healing process of cryopreservation tissue lens after epikeratophakia by in vivo confocal microscopy. Method Epithelia, stroma and nerves of tissue lens, interface between lens and recipient and stroma and endothelia of recipient were observed by in vivo confocal microscopy and recorded by video in 24 cases of keratoconus from 3 days to 5 years after epikeratophakia. Results Epithelial layer of lens: The tissue lens was covered by corneal superficial flat cells with wing cells and basal cells on the periphery at 3 4 days postoperatively, but the morphology and arrangement of these cells were irregular with low density. Superficial flat cells took shape completely at one month, and the morphology and density of the basal cells tended to be normal at 6 months postoperatively. Subepithelial nerve plexus were scattered at 18 months and their normalization completed at 2 years postoperatively. Stroma of lens: Keratocytes appeared circular, dot shaped, rod shaped or reticular in morphology postoperatively. Normal keratocytes were discovered sporadically on the periphery of the lens at 2 years postoperatively. At 5 years postoperatively the density of keratocytes was lower than normal stromal keratocyte in the center of the lens. Stromal nerves of lens: Nerves could grow into tissue lens at 6 months postoperatively, the quantity of nerves increased at 2 years and was still less than normal quantity at 5 years postoperatively. Stroma and endothelia of recipient: There was no change in the stroma and endothelia of recipient. Conclusions There is significant difference among healing process of epithelia, nerves of unvital tissue lens after epikeratophakia, but there is little change in the transparency of tissue lens.