中国人正常角膜的共焦显微镜检查

In vivo confocal microscopy of normal chinese corneas

探讨正常人共焦显微镜下角膜各层细胞的活体细胞形态学特征及密度。方法 :对 2 8例 (年龄 :36 .6± 14.5岁 ,范围 :19～ 6 8岁 ) 4 1眼 (男 14眼 ,女 2 7眼 )正常人中央部角膜进行活体共焦显微镜检查 ,描述角膜各层结构的图象特点 ,并分析角膜各层细胞的密度与年龄的相关性。结果 :上皮表层细胞排列疏松 ,边界清楚 ,核反光较强 ;基底层细胞排列紧密 ,胞质和核反光弱 ,偶尔可见点状细胞核 ,细胞平均密度为 5 72 4.41± 5 6 2 .5个 / mm2。Bowman s膜为无一定形状的膜状物 ,仅可分辨的结构是上皮下的念珠状神经纤维。基质层中可见相对较暗的背景下明亮的角膜细胞核。前基质内有放射状分布的神经纤维。前基质层角膜细胞平均密度为 10 99.10± 16 4.90个 / mm2 ,后基质层角膜细胞平均密度为 75 4.37± 90 .37个 / mm2 ,前后基质层细胞密度有显著性差别 ( P<0 .0 0 1)。 Descem et s膜结构不清。内皮层表现为规则的六边型镶嵌体 ,胞体明亮 ,细胞平均密度为 3179.2 0± 2 2 1.0 3个/ mm2 。角膜内皮细胞数量与年龄呈明显的负相关 ( r=- 0 .879,P<0 .0 0 0 1) ,而其他各层细胞的密度变化与年龄的增长无相关关系 ( r=- 0 .0 0 4～ - 0 .879,p=0 .2 0 7～ 0 .979) 。

To study cellular morphology and density of the normal chinese corneas .Methods:With in vivo confocal microscopy,the study group consisted of 41 eyes of 28 patients with normal corneas(14 males,27 females).The age distribution was 36 6±14 5 years(mean±SD;range,19—68).The images were analyzed visually for morphology of corneas and the densities of cells were countered by NAVIS software.The correlation between the densities of cells and ages was analyzed.Results:The borders of the surface epithelial cells were readily seen,as were the bright cell nuclei.Basal epithelial cells were separated by light cell boundaries with less bright reflection of cytoplasm and nuclei.The basal epithelial cell density was 5724 41±562 5 cells/mm 2.The Bowmans layer appeared as an amorphous membrane and could be distinguished by the fine headed nerve plexus immediately associated with the basal cells.In the corneal stroma,only keratocyte muclei were visible against a darker background.The average apparent keratocyte density was 1099 10±164 90 cells/mm 2 in anterior stroma,and 754 37±90 37 cells/mm 2 in the posterior stroma.The difference in apparent keratocyte density between the anterior and the posterior stroma was statistically significant(p<0 001).The mosaic of the regular hexagonal endothelial cells was seen.The average endothelial cell density was 3179 20±221 03 cells/mm 2,and had a significant negative correlation with age(r=-0 879,p<0 001).The densities of the other corneal cells did not have a statistical significant correlation with ages(r=-0 004—-0 879,p=0 207—-0 979).The difference between the left eyes and the right eyes was not significant,as well as the sex(p=0 156-0 844,p=0 175-0 933).Conclusion:In vivo Confocal miscrocopy can offer qualitative and quantitative analysis in real time and 3D condition to all layers of cornea.It has the noninvasive observation,high magnification and distinguishing character.There is clinical value in early diagnosis and treatment and the study of pathological morphology.