激光共焦显微镜对正常人中央角膜的观察

Observation of normal human central corneas using laser confocal microscope

目的:利用激光共焦显微镜观察正常人的中央角膜组织结构和细胞形态。方法:对54例(68眼)患者进行激光共焦显微镜连续扫描,使用激光共焦显微镜对其角膜中央区进行检查,拍摄各层角膜图像,观察组织结构和细胞形态,对细胞密度进行计数并分析。结果:角膜组织学结构:上皮细胞较其它细胞的体积小,数量多,随深度增加细胞逐渐变小。Bowman膜较薄,无明显细胞结构,层间有神经走形。基质层的细胞核围成"网眼"状结构,随深度加深,"网眼"变大,排列变松。Descemet膜表现为一个与后基质层和内皮层交织的移行带。内皮细胞为六边形结构,排列规则。角膜细胞密度:在各年龄组间,上皮细胞表层与基底层之间的差异均有统计学意义(P<0.01),前基质层细胞密度与中、后基质层密度之间有统计学差异(P<0.05)。A组和D组的内皮细胞密度有统计学差异(P<0.05)。其余各年龄段的角膜各层细胞密度,随年龄的增加,数差异均无统计学意义。结论:激光共焦显微镜可以在实时、活体和三维空间从细胞水平对角膜各层结构进行无创的定性定量分析,较传统光学共焦显微镜能获得更清晰、更密集的角膜图像,对角膜疾病的基础研究与临床诊断具有很高的价值。

AIM： To observe central corneal structure and cell morphology of normal human by laser confocal microscope. METHODS： Fifty four cases （68 eyes） with laser scanning confocal microscope. To inspect central corneal zone by laser confocal microscopy. Photographing all levels of the corneal image and observing the organizational structure and cell morphology, Count cell density and analysis. RESULTS： Histological structure of the cornea： the epithelial cells have little volumn and large amount than other cells. The basal cells were smaller than the surface ones. The Bowman＇s layer appeared as an amorphous membrane and could be distinguished by the dence nerve plexus.The keratocyte nuclei surrounded like many ＂ meshes＂ in stroma layers. The ＂meshes＂ became larger and looser in the posterior stroma. Descemet＇s membrance was a displaced zone between the posterior stroma and the endothelial layers. The mosaic of the regular hexagonal endothelial cells was seen. The cell densities： In each group, the statistical difference existed in the density of the surface epithelial cells and the basal ones （P〈 0.01）. The difference in the keratocyte density of the anterior stroma from that of the middle and posterior stroma was statistically significant （ P 〈 0.05 ） . The endothelial cell densities in group A were significantly different from those of group D （ P 〈 0.05）. No statistically significant differences were found in cell densities in any other corneal layers. CONCLUSION： Laser confocal microscope can offer noninvasive observation and qualitative and quantitative analysis in real-time and 3D condition to all layers of cornea. The images have high definition and exact depth localization.