分泌减少性干眼症角膜共焦显微镜下的形态学改变

Morphologic alteration of secretion-reducing dry eye syndrome with corneal confocal microscope

目的应用角膜共焦显微镜活体、无创观察分泌减少性干眼症患者的角膜上皮及上皮下神经纤维的形态学改变。方法选择临床确诊为分泌减少性干眼症的患者37例(73眼)。印迹细胞学检查对患眼进行干燥程度分级,应用角膜共焦显微镜观察角膜上皮下神经纤维的形态学改变,及角膜上皮细胞密度定量测定。结果干眼症患者干燥斑处有明显的角膜上皮细胞坏死脱落区,反光极强;细胞间隙明显增宽,局限上皮细胞缺损、排列稀疏。部分患者呈扁平形浅表层角膜上皮细胞缺失。角膜上皮下神经纤维出现分支紊乱、异常走行弯曲,神经纤维不均匀增粗、增生,7眼未见上皮下神经纤维。干燥程度分级≤Ⅱ级者6眼,角膜上皮细胞密度为(629±168)个/mm2;Ⅲ级者51眼,细胞密度为(615±181)个/mm2;≥Ⅳ级者16眼,细胞密度(605±108)个/mm2,分别与正常眼比较,差异均有统计学意义(P<0.05)。结论分泌减少性干眼症角膜共焦显微镜下呈现角膜上皮细胞密度降低、上皮下神经纤维的特征性异常改变,与干眼症干燥程度密切相关。

Objective Coneal confocal microscope is an useful tool to the morphological observation of corneal epithelium, stroma and endothelium. The goal of this paper was to provide a safe and quick diagnostic method for dry eye syndrome patients by the use of corneal confocal microscopy. Methods Thirty-seven patients （73 eyes） confirmed as secretion-reducing dry eye syndrome were included in this study. The age range of patients was from 17 to 66 years old. In comparison with the corneal epithelia density of normal people in database, the degree of dryness was graded based on the quantitative impression cell test result, corneal epithelia density and the morphological change of the nerve fiber under the corneal confocal microscope. Results The corneal epithelial cell density was （629 ± 168 ）cells/mm^2 in 6 eyes, （615 ±181 ）cells/mm^2 in 51 eyes and （605 ± 108）cells/mm^2 in 16 eyes,showing a statistically significant decrease in comparison with normal value（ 1 200 ± 370）cells/mm^2 （P 〈 0. 05）. Distinct corneal epithelioid cell obseission zone at the xeransis spot with strong glisten were found. Wideness of cell clearances, damage and sparse epithelioid cell,lessen of cell layers were observed. Ramus disarray and abnormal bend of nerve fibers under corneal epithelium,inequable thickening and changed hyperplasia occurred in 7 eyes. Based on the classification of Tseng,6 eyes was for ≤Ⅱ grade,51 eyes for Ⅲ grade and 16 eyes for ≥ Ⅳ grade. Conclusion The decrease of epithelioid cell density and abnormal characteristic change of nerve fibers of subepithelium is closely related to the dryness. The disappearance and change of subepithelial nerve fiber may be related to the constitutional eye disease.