共焦显微镜观察虹膜角膜内皮综合征及其继发性青光眼的手术治疗

Confocal microscopy in the iridocorneal endothelial syndrome

目的应用共焦显微镜检查探讨虹膜角膜内皮综合征的临床特征及其继发性青光眼的手术治疗。方法 8例(8眼)虹膜角膜内皮综合征行共焦显微镜下双眼检查;描述角膜内皮的病变结构特点,分析双眼角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例及中央角膜厚度,并对6例继发性青光眼中的5例施行手术治疗。结果患眼角膜内皮细胞呈风筝样或上皮细胞样改变;细胞排列紊乱,大小不均;细胞内可见高反光的细胞核,部分可见双核。患眼和对侧眼的角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例分别为:789.7±75.8个/mm2、2223.7±80.6个/mm2;1106.9±89.4μm2、379.8±20.6μm2;17.2±1.2%、56.3±1.7%,下降明显。二者的中央角膜厚度相当。4例继发性青光眼手术后眼压控制正常,另1例手术无效。结论共焦显微镜能够发现ICE患者的角膜内皮细胞的特征性改变;对该病的诊断具有很高的临床意义。并发继发性青光眼要及时手术治疗控制眼压。

Objective To investigatae the appearance of iridocorneal endothelial syndrome（ICE） and the surgery of complicated glaucoma by confocal microscopy.Methods Eight patients （8 eyes）,each with unilateral ICE syndrome,had both their eyes examined by confocal microscopy.The images were recorded and analyzed by the use of proprietary software.Endothelium density,average endothelial area,percentage of hexagonal cells,and central corneal thickness were measured.A non-parametric test was used to compare differences between the affected eye and the contralateral healthy eye.Five cases of the six cases of complicated glaucoma had undergone surgery. Results In vivo confocal microscopy highlighted two main patterns of endothelial changes：＂kite-like＂ and ＂epithelial-like＂ abnormal endothelium,characterized by marked hyperreflective nuclei and loss of regularity in cellular size and shape.The endothelium density,average endothelial area,percentage of hexagonal cells of the affected eyes and the contralateral eye were：（789.7±75.8）/mm^2,（2223.7±80.6）/mm^2;（1106.9±89.4）μm2,（379.8±20.6）μm,（217.2±1.2）%,（56.3±1.7）% respectively.The differences had statistical significance（P〈0.05）.The central corneal thickness had no difference between the two groups.The intraocular pressure of 4 cases in the 5 cases undergone anti-glaucoma surgery were controlled. Conclusion The application of confocal microscopy indicates ICE characterise of epithelial cells.The technique has great potential in diagnosing ICE.