共焦显微镜观察2型糖尿病患者角膜神经分布及形态学特征

Distribution and morphological changes of corneal nerves in type 2 diabetic patients detected by confocal microscopy

目的探讨2型糖尿病患者共焦显微镜下的角膜神经分布及形态学特征。方法应用 Confoscan 3.0共焦显微镜观察59例(65只眼)2型糖尿病患者和26例(26只眼)同年龄对照组白内障手术患者的中央角膜神经分布和形态学特征,依据双目间接检眼镜和荧光素眼底血管造影检查结果,将糖尿病患者分为3组:糖尿病无眼底改变(NDR)组、非增生性糖尿病视网膜病变(NPDR)组、增生性糖尿病视网膜病变(PDR)组,记录并分析患者角膜上皮下神经丛和角膜基质神经图像。结果与对照组相比,2型糖尿病患者角膜上皮下神经丛神经分支密度、神经纤维长度均减少,差异有统计学意义(P<0.01),神经纤维的密度仅 PDR 组明显减少,NPDR 组、NDR 组减少不明显。角膜基质中形态异常的神经纤维在糖尿病患者中出现的几率也明显高于对照组,两组差异有统计学意义(P<0.01)。结论共焦显微镜是一种有效、无创的角膜神经检查方法,2型糖尿病患者角膜上皮下神经丛、角膜基质神经均显示形态学异常。(中华眼科杂志,2006,42:896-900)

Objective To evaluate corneal nerve distribution and morphological changes in subjects with type 2 diabetes. Methods Sixty-five eyes of 59 patients with type 2 diabetes （26 males, 39 females） and 26 eyes （ 10 males, 16 females） of control subjects were included in the present study. Based on the indirect ophthalmoscopic examination and fluorescein angiography, the diabetic group was divided into three sub-groups according to the stage of retinopathy： without diabetic retinopathy （NDR） , non-proliferative diabetic retinopathy （NPDR） and proliferative diabetic retinopathy （PDR）. The central cornea was scanned with Confoscan 3.0. The images of subbasal nerve plexus and stromal nerves were analyzed. Results Corneal branch nerve fiber density of subbasal nerve plexus decreased in diabetic group as compared with control group, the difference was statistically significant. The decrease of nerve fiber density appeared only in the PDR sub-group, while the decrease was not significant in NDR and NPDR sub-groups. No obviously difference was found among control group, NDR and NPDR sub-groups. The proportion of patients with an abnormal morphologic nerve fibers in mid-stroma in diabetes group was greater than that in the control group and the difference was statistically significant （x^2 = 46. 613 , P = 0. 000）. Conclusions Corneal confocal microscope allows rapid and noninvasive in vivo evaluation of corneal nerves. The subbasal and stromal nerves of subjects with type 2 diabetes were abnormal in morphology. （Chin J Ophathalmol, 2006,42：896-900）