真菌性角膜溃疡刮片前后的共焦显微镜对照研究

Comparative study of the laser scans confocal microscopy examination of fungal corneal ulcer before and after the corneal scraping

目的对活体真菌性角膜溃疡患者刮片前后的病灶，采用角膜激光共焦显微镜进行观察、比较并总结其特点。方法取45例（45只眼）角膜溃疡刮片、培养确诊真菌性角膜溃疡的患者，在角膜刮片取材培养前后，采用激光角膜共焦显微镜进行检查，研究其图像特点，并进行对比。结果在真菌l生角膜溃疡刮片取材前，溃疡灶中的真菌菌丝在活体角膜激光共焦显微镜中结构完整、成像清晰。刮片取材后，溃疡灶中的真菌菌丝在活体角膜激光共焦显微镜中结构不完整、成像较模糊，菌丝有断裂。结论角膜刮片取材会造成真菌性角膜溃疡灶中的真菌菌丝断裂，对真菌性角膜溃疡进行活体共焦显微镜的最佳检查时间应在角膜刮片取材前进行，以提高共焦显微镜对真菌性角膜溃疡的检出水平。

Objective To study the cellular morphology of fungal corneal ulcer by laser scans confocal microscopy in vivo before and after the corneal scraping. Methods Forty-five cases （45 eyes） of fungal corneal ulcer were examined by laser scans confocal microscopy in vivo before and after the corneal scraping. Images were recorded by continuously focusing on the optical section through the corneal ulcer. The images were analyzed visually for morphology and compared with each other using Heidelberg Tomograph II Cornea Module. Results The cellular morphology of hyphae with laser scans confocal microscopy in fungal corneal ulcer was intact and clear before the corneal scraping. Af- ter the corneal scraping, the cellular morphology of hyphae with taser scans confocal microscopy in fungal corneal ulcer get broken and shadowy. Conclusions The corneal scraping will make the hyphae broken in fungal corneal ulcer. We must take the examination of the laser scans confocal microscopy in vivo before the corneal scraping to improve the diagnostic level in the fungal corneal ulcer in the clinic.