Chandler综合征的共焦显微镜研究

Confocal microscopic research of cornea with Chandler syndrome

目的应用角膜激光共焦显微镜观察Chandler综合征患者活体角膜各层组织的形态特点。方法对21例（21只眼）的Chandler综合征患者，采用角膜激光共焦显微镜观察其活体角膜的各层结构，总结其图像特点。结果共焦显微镜下Chandler综合征患者角膜有如下特点：（1）角膜上皮细胞及角膜基质细胞在共焦显微镜下可有不同程度的水肿。（2）角膜营养不良是Chandler综合征患者的特征性改变之一，在共焦显微镜下角膜内皮细胞出现不同程度的疣锥状突起，病变的内皮细胞彻底丧失六边形结构，细胞变圆、变大，在中高反光的细胞体外有一圈由于细胞突起引起的暗反光圈结构，严重的患者可以形成山脊状隆起。（3）部分患者的虹膜在共焦显微镜下可出现粗细不同的支架状结构，这些虹膜支架结构在共焦显微镜下呈中一高度反光，部分呈树枝状排列，部分呈树干状排列，其周围可散在大小不同的色素颗粒附着。结论共焦显微镜在临床诊断Chandler综合征中有重要作用，角膜营养不良是Chandler综合征患者的特征性改变之一，在共焦显微镜下角膜内皮细胞出现不同程度的疣锥状突起，这种内皮细胞是Chandler综合征与其他类型ICE综合征鉴别的特点之一。

Objective To research the morphological characteristics of different layers tissue of cornea with Chandler syndrome by laser eonfocal microscopy in vivo. Methods Twenty-one eyes of 21 patients with Chandler syndrome were examined by laser confocal microscopy in vivo, and the characteristics of images were studied and analyzed. Results The characteristics of cornea with Chandler syndrome observed by in vivo confocal microscopy were as follows： There was different edema of corneal epithelial cells and stromal cells. Corneal dystrophy was one of the characteristics of Chandler syndrome. The different cone warts protrusions of corneal endothelial cells were ob- served by laser confocal microscopy. The endothelial cells of the lesions completely lost the hexago- nal structure; the cells became round and larger. There was dark-reflective structure out of the high-reflective circle due to cell protrusions. The stent-like support structure of the iris with different thickness was observed by confocal microscope in vivo. The support structure of iris was moderate to high reflection under the in vivo confocal microscope, some of which were dendritic arrangements, some of which were trunk-like arrangements, attached to it there were scattered pigment granules in different sizes. Conclusions Confocal microscopy has an important role in the clinical diagnosis of Chandler syndrome. Corneal dystrophy is one of the characteristic changes in patients with Chandler syndrome. The different warts cone protrusions of corneal endothelial cells are observed by confocal microscopy in vivo. The special endothelial cells are one of the characteristics to distinguish Chandler syndrome from other ICE syndrome.