干扰素α-2b及5-氟尿嘧啶治疗眼表鳞状细胞肿瘤后角膜微结构变化

The change of corneal microstructural of patients with ocular surface squamous neoplasia after treatment with topical interferon alfa-2b and 5-fluorouracil

目的观察干扰素α-2b(IFNα-2b)及5-氟尿嘧啶(5-FU)治疗眼表鳞状细胞肿瘤(OSSN)后角膜微结构的变化。方法回顾性系列病例研究。对16例(16眼)OSSN以IFNα-2b(100万IU/mL)及1%5-FU每日4次滴眼,用药前后以活体共焦显微镜(IVCM)观察瘤体及瘤体下方角膜的改变。结果治疗后4个月瘤体细胞的多形性明显减轻、反光明显降低,病变区域异常细胞与正常上皮细胞边界模糊不清;基底细胞"星空外观"减少甚至消失;上皮下神经纤维重新出现并逐渐增多。另外,角膜树突状细胞明亮的伴有小突起的细胞颗粒变为高反射密集、较大分支结构的细胞。结论IVCM观察到了局部应用IFNα-2b及5-FU后OSSN上皮细胞的多形性减轻、反光降低及角膜树突状细胞密度增加。

Objective To observe the change of corneal microstructural of patients with ocular surface squamous neoplasia(OSSN)after treatment with topical interferon alfa-2b(IFNα-2b)and 5-fluorouracil(5-FU).Methods A retrospective case series study.Total of 16 eyes of 16 patients with OSSN were treated with topical IFNα-2b(1 million IU/mL)and 1%5-FU four times a day.The inneoplastic lesion and the cornea under involved areas were observed with in vivo confocal microscopy(IVCM)before and after treatment.Results Main features of OSSN at 4 months after treatment showed reduction reflectivity of epithelial cells,loss of cellular pleomorphism and demarcation line between normal and neoplastic tissue.Basal cell layers containing bright dots were found to diminish or disappear gradually.Other change was the reappearance of distinctsubbasal nerves.A few dendritic cells appeared as bright cellular particles with small dendritic processes that transformed into large and highly reflective arborizing cells were found.Conclusion The reduced reflectivity and polymorphhism of epithelial cells,and the increasing density of limbal dendritic cells after topical IFNα-2b and 5-FU therapy are observed with IVCM.