激光共焦显微镜下圆锥角膜交联术后角膜基质的观察

The observation of cornea stroma with laser confocal microscopy after corneal collagen cross-linking

目的通过角膜激光共焦显微镜观察圆锥角膜交联术后基质的变化。方法收集2018年12月至2019年7月于西安市第一医院和深圳市第六人民医院确诊为进展期圆锥角膜患者,行等渗核黄素液角膜交联手术,于术后1周、1个月、2个月、3个月、4个月、5个月、6个月行角膜激光共焦显微镜观察角膜基质形态的变化,并测量相应变化处角膜的深度。结果角膜交联术后1周基质胶原纤维水肿增粗,细胞激活、细胞核反光增强,病变深至角膜(210.2±2.2)μm处;术后1个月、2个月、3个月基质胶原纤维水肿、排列不规则,可见高反光瘢痕,分别深至角膜(209.4±2.8)μm、(210.1±2.1)μm、(209.2±2.6)μm处;术后4个月胶原纤维水肿消退、排列趋于规则,瘢痕深至(179.0±2.4)μm,术后5个月,胶原纤维排列规则,瘢痕深至(146.3±2.1)μm,术后6个月,胶原纤维排列规则,瘢痕深至(128.1±2.3)μm。术后前3个月病变最深处差异无统计学意义,3个月与4个月、4个月与5个月,5个月与6个月差异有统计学意义(P<0.05)。结论角膜交联术后,基质胶原纤维由水肿、排列紊乱逐渐重塑规则;基质细胞激活、出现瘢痕并于术后3个月开始逐渐从深开始消减。

Objective To observe the changes of cornea stroma by corneal laser confocal microscopy in patients with progressive keratoconus who had received corneal collagen cross-linking.Methods Patients with progressive keratoconus diagnosed at the First Hospital of Xi’an or the Six Hospital of Shenzhen during December 2018 to July 2019 were recruited in this study.The included patients received corneal collagen cross-linking,and the cornea stroma was observed and corneal thickness was measured using corneal laser confocal microscopy at 1 week,1 month,2 months,3 months,4 months,5 months and 6 months postoperatively.Results At 1 week after corneal collagen cross-linking,edema of the corneal collagenous fiber,cell activation and enhanced nuclear reflection were observed.And these changes reached the thickness of 210.2±2.2μm of the cornea.At 1 month,2 months and 3 months postoperatively,edema,misalignment and high reflective scarring of the collagenous fiber could be observed at as deep as 209.4±2.8μm,210.1±2.1μm and209.2±2.6μm of the cornea,respectively.At 4 months postoperatively,edema of the collagenous fiber disappeared,and the scars reached the thickness of 179.0±2.4μm.At 5 and 6 months postoperatively,the alignment of corneal collagenous fiber was regular,and the scars reached the thickness of 146.3±2.1μm and 128.1±2.3μm,respectively.There was no significant change in the depth of scar during the first 3 months after the surgery,while the difference in the depth of scar between 3 and 4 months postoperatively,4 and 5 months postoperatively,as well as 5 and 6 months postoperatively were statistically significant(P<0.05).Conclusions After corneal collagen cross-linking,the corneal gradually recovered from collagenous fiber edema and misalignment,cell activation were observed and the corneal scar began to recover at 3 months after the surgery.