共焦显微镜观察慢性角膜水肿患者角膜各层形态特点

目的：应用活体共焦显微镜(IVCM)观察慢性角膜水肿患者角膜各层形态特点。

方法：使用IVCM观察不同病因的慢性角膜水肿的患者21例21眼，并与5例拟行白内障手术患者的正常角膜进行对照。

结果：IVCM观察到所有慢性角膜水肿患者角膜上皮层均可见大泡，表现为黑色、圆形、边缘清晰。18眼(86%)上皮细胞出现高反射的无细胞结构的片状区域和瘢痕。12眼(57%)患者中央区角膜上皮下未发现神经纤维，9眼(43%)患者中央区角膜上皮下神经平均密度显著降低。所有患者Bowman膜(BZ)表现为明显的异常，除了瘢痕外，BZ呈分支的、细的、黑线状。13眼(62%)患者前基质表现为细颗粒或粗颗粒，且反光不同。所有患者角膜基质细胞密度降低。所有患者角膜内皮表现为正常六边形结构消失，细胞边界不清。对照组角膜正常未见上述改变。

结论：IVCM可以用来观察慢性角膜水肿角膜各层微观结构上的变化，包括上皮瘢痕形成、上皮下神经纤维及基质细胞的减少。随着角膜内皮移植术的日益普及，本研究支持IVCM在定量评估术前、术后角膜水肿的作用。

Confocal microscopy features in chronic corneal edema

AIM: To report in vivo confocal microscopic(IVCM)in corneal edema.

METHODS: Twenty-one patients with clinically diagnosed corneal edema were involved. All cases, in addition to control group of five normal eyes, were examined with IVCM.

RESULTS: IVCM findings in corneal edema showed that epithelial bullae appeared as dark, round areas with well-defined margins in all of the patients; Subepithelial fibroblasts and scarring; Other IVCM features included absent(57%)or reduced(43%)subbasal nerves in central corneal; Apart from the associated scar tissue, BZ presented a branching pattern of fine, darklines in all of the patients. Furthermore, fine or coarse granularity with avariable degree of reflectivity were noted in the anterior stroma in 13 of the 21 cases(62%); The number of keratocytes in the stroma of corneas was less than that in the normal corneas measured by using confocal microscopy in all of the patients; Endothelial changes with total obscuration of endothelial cell borders were seen in all of the patients. IVCM findings in the control group showed normal patterns.

CONCLUSION: This is the study in which IVCM features of corneal edema have been found in detail. Subepithelial fibroblasts, reduced subbasal corneal nerves and stromal keratocyte were well documented in this study. With increasing popularity of endothelial keratoplasty this work supports the role of IVCM in quantitative evaluation of corneal edema in preoperative stages, as well as after surgery.