活体共聚焦显微镜在原发性翼状胬肉术前组织病理学特点分析应用

The clinical value of in vivo confocal microscopy in investigating the pathological characteristics of primary pterygium before surgery

目的用活体共聚焦显微镜分析原发性翼状胬肉组织病坪学特点，探讨其发病机制：方法筛选21例重度原发性翼状胬肉，记录性别、年龄、发病H^f．J及眼部疾病史，同时仃常规眼部裂隙灯愉查、眼前节像、眼前节OCT和活体共聚焦显微镜检查？结果2l例（21只眼）翼状胬肉均为单跟、鼻侧发生，胬肉头部已达瞳孔缘或部分遮盖瞳孔区，其巾男性13例，女性8例；平均年龄（65_3±1．4）岁（52～81岁），平均发病时间：（12．1±0．8）年（8．6～20年）；5例血管型，6例纤维型，10例f昆合型。眼前节OCT示所有胬肉组织均不同程度侵犯角膜上皮层、前弹力层和浅基质层，而与巩膜组织界限较清。活体共聚焦显微镜下胬肉体部上皮细胞表层有炎性细胞和树突状细胞少量侵入，而深层侵入明显；胬肉头部上皮各层均有大量炎性细胞和树突状细胞侵入，同时在交接处角膜上皮层巾也观察到炎性细胞和树突状细胞侵入？结论活体共聚焦显傲镜町提供活体翼状胬肉组织病理细胞学特征，为研究其发病机制提供一种崭新、可靠的研究方法？

Objective To determine the clinical value of in vivo confocal microscope in investi-gation of the etiopathogenesis of primary pterygium. Methods A case series with 21 consecutive cases of primary pterygium was investigated, of which the patients＇ information and disease history were recorded. The structure and cellular features of primary pterygium were estimated by split lamp, anterior segment photography optical coherence tomography （AS-OCT）, and in vivo confoeal microscopy. Results All the 21 primary pterygia were unilateral, defined as sever ptergium, originat- ed from the nasal conjunctiva, and the heads of the winglike ptergia all arrived at the pupillary mar- gin or partially covered the papillary region. There were 13 males and 8 females in the participants, with average age at 65.3~1.4 （from 52 to 81 years old） and mean course of disease at 12.1--0.8 years （from 8.6 to 20 years）. The histopathological patterns of the 21 pterygium cases consisted with 5 vascular types, 6 fibrous types and 10 mixed types. According to the AS-OCT, the primary pterygia invaded the cornea at different levels, including epithelial layer, Bowman＇s layer and superfi- cial stroma, although all of which held clear borders with the sclera. In vivo confocal microscopy re- vealed that inflammatory cells and dendritic cells infiltrated the deep layer of pterygium epithelium but not the surface layer. Especially at the head of pterygia, large number of inflammatory cells and dendritic cells infiltrated all the layers of epithelium, as well as the adjacent corneal epithelium,which could be typical observed in the mixed type of pterygia. Conclusions In vivo confocal mi- croscopy can be applied to investigate the which provide a novel and reliable method to histopathological characteristics of primary pterygium, study the etiopathogenesis of primary pterygium.