圆锥角膜各期的共焦显微镜表现

目的评价共焦显微镜在圆锥角膜临床研究中的应用价值。方法应用共焦显微镜观察圆锥角膜患者32例（48眼）及正常对照组17例（28眼），分别比较早、中、晚期圆锥角膜与正常对照组的图像特点。结果早期圆锥角膜出现激活状态的角膜细胞、浅基质层的细小皱褶、深基质层的暗纹、部分内皮细胞异形性明显，中、晚期圆锥角膜出现角膜上皮细胞拉伸、细胞核皱缩；基质细胞排列紊乱、基质层暗纹；而对照组未发现上述表现。各期圆锥角膜的角膜基质层厚度、不同深度角膜基质细胞密度、内皮细胞密度与对照组之间差异有统计学意义（P〈0．05）。结论共焦显微镜对早期圆锥角膜的发现以及圆锥角膜病理发展的研究具有重要的临床价值。

Evaluation of different stages of keratoconus with confocal microscopy

ObjectiveConfocal microscope has been widely applied in the early diagnosis and pathological morphological research of different corneal diseases.As a new optical microscope,confocal microscope can scathelessly scan the corneal tissue and form an optical faultage image of the living object in real time and in three-dimensions fashion.This study was to evaluate the confocal microscope findings of keratoconus.MethodsForty-eight unscarred corneas from 37 patients with keratoconus and 28 corneas of 17 controls were examined using confocal microscopy.Keratoconus eyes were divided into mild cases (28 eyes ),moderate cases (10 eyes ) and advanced cases (10 eyes ).The findings of confocal microscope were recorded,and the thickness of corneal stroma,keratocyte density and corneal endothelial cell density were measured.ResultsIn mild keratoconus cases,the more high-light keratocytes in anterior stromal layers,rumples in the anterior portion and dark stripes in the posterior portion of corneal stroma were seen.The dark stripes were longitudinal or diagonal,and the corneal stroma cells distributed along the dark stripes.Some cases showed veriform endothelial cells.In moderate and advanced keratoconus cases,the corneal epithelium cells were enlarged but the cellular nuclear was lessen,and thickening of dark stripes,a sheet of bright area and smaller keratocytes in the stroma were displayed.Corneal stromal thickness,keratocyte density at different stromal layer and corneal endothelial cell density were significant reduced in different stages of keratoconus in comparison with controls.ConclusionConfocal microscope is an useful tool for diagnosis of keratoconus and study of the pathological development of keratinous.