翼状胬肉的激光共焦显微镜观察

In vivo evaluation of pterygium by corneal laser confocal microscopy

目的翼状胬肉是常见的眼表面疾病,活体显微结构的观察有助于治疗与随访。方法用海德堡角膜激光共焦显微镜观察了20例原发性翼状胬肉(翼状胬肉组)以及20例正常志愿者(对照组)的结膜和角膜缘。比较了2组角膜各部分细胞数及中央厚度,并对翼状胬肉的血管、树突状细胞数与对照组的的角膜缘进行了比较。结果角膜激光共焦显微镜扫描的图像能清晰地观察翼状胬肉患者眼表面的超微结构,包括翼状胬肉周围角膜浅层神经的形态、上皮及其与角膜交界的边缘,翼状胬肉的基质及其血管和浸润的炎性细胞。与正常眼表面相比较,翼状胬肉生长的眼表面,其角膜基底部上皮细胞、前基质细胞、后基质细胞、内皮细胞数量以及中央角膜厚度无显著改变,翼状胬肉基质中的血管密度显著高于正常角膜缘(P<0.05)。翼状胬肉组织浅层及其边缘可见较多的树突状细胞,数量显著高于正常角膜缘(P<0.05)。结论角膜激光共焦显微镜可对翼状胬肉进行精确活体观察。

Objective Pterygium is a common ocular surface disease.In vivo observation of its microstructure helps the treatment and follow-up of the disease.Methods We examined in vivo the conjunctival and corneal limbi of 20 patients with primary pterygia and 20 healthy subjects by corneal laser confocal microscopic imaging(Heidelberg Retina Tomograph Ⅱ Rostock Cornea Module),and compare between the two groups the numbers of epithelial cells,stromal cells and endothelial cells and central corneal thickness.The counts of microvessels and dendritic cells in pterygium were also compared with those in the limbus of the normal subjects.Results The corneal laser confocal microscopic images clearly revealed the ultrastructure of the ocular surface,including the morphology of the corneal nerves,pterygial epithelium and its border,pterygial stroma and its vascularization,and dendritic cells.Compared with the normal controls,the pterygium patients showed no significantly changes in the numbers of epithelial cells,stromal cells and endothelial cells,nor in the central corneal thickness.However,a significantly higher density of microvessels and a larger number of dendritic cells were observed in pterygium than in the limbus of the healthy subjects(P<0.05).Conclusion Corneal laser microscopic imaging allows a precise evaluation of pterygium in vivo.