角膜激光共聚焦显微镜检查在角膜深层异物诊断中应用

Clinical application of diagnosis in small foreign body occurred on the cornea deeply by laser corneal confocal microscopy

目的探讨在受伤眼角膜创面水肿严重，异物体积小，位置深，裂隙灯检查困难的情况下，应用角膜激光共聚焦显微镜协助判断角膜异物的位置，大小，质地等的临床价值。方法临床病例分析研究。对深圳市眼科医院2011年8月至2012年12月角膜病科收治的17例（17只眼）角膜深层异物伤患者，角膜创口闭合，创面水肿严重，异物体积小，位置深，裂隙灯检查困难，但B超、X片及CT检查提示因角膜深层异物存在。对17例伤眼使用角膜激光共聚焦显微镜检查，分析研究其图像特点，总结角膜深层异物在活体角膜的共聚焦显微镜表现。结果共聚焦显微镜检查结果提示：异物在角膜深基质层，内皮层内表现为不同程度的高回声声像，轮廓清楚，内部回声较均匀，多呈棒状或块状；并伴有周边角膜基质细胞和内皮细胞的明显水肿增大。结论角膜激光共聚焦显微镜能够在活体和三维空间协助确定临床上难以判断的角膜深层异物的有无，可能位置，大小及大致的质地，对诊断和手术提供有价值的影像证据。

Objective To evaluate the clinical value of the corneal laser confocal microscope for judge the position, size and material quality of the foreign body with serious cornea edema, small, deep, and difficult to inspect the situation of the foreign body. Methods Seventeen cases were treat-ed in the Shenzhen eye hospital during October 2011 to December 2012, patients whose cornea were injured by foreign body that were difficult to find by slit lamp with the closed wounds, seri-ous edema, small and deep positions, while B ultrasonic, X-ray and CT examination pointed out the existence of the foreign body, 17 eyes were examined by corneal laser confocal microscopy, then the characteristics of the image were analyzed, and the performance of the deep corneal foreign body in vivo corneal confocal microscope were summarized. Results The results suggested that the varying degrees of high echo image of the foreign body in deep stroma and endothelium, the con-tour was clear, internal echo was uniform and the shape was club-shaped or nubby, associated with peripheral corneal stroma cells and endothelial cells were edema obviously. Conclusions Laser cor-neal confocal microscopy can assist in determining the existence, position, size and rough texture of corneal foreign bodies in vivo and in three-dimensional space, provide the image evidence of value in the diagnosis and operation.