角膜内皮炎药物治疗转归的共聚焦显微镜观察

In vivo confocal microscopy study of corneal endotheliitis after medicine treatment

目的利用共聚焦显微镜(HRT-II)观察角膜内皮炎患者治疗前后各层细胞、组织的形态学改变, 总结其变化特点。方法 2012年3月至2014年2月期间在我院确诊为角膜内皮炎患者32例, 给予局部抗病毒及激素点眼, 重度患者及伴有全身病毒感染症状的患者给予口服抗病毒药, 合并青光眼患者加用抗青光眼眼药水。用HRT-II对患者治疗前及治疗后4周进行检查, 观察病变区角膜上皮细胞、上皮下神经纤维密度、朗罕氏细胞(LCs)的数量及角膜内皮细胞形态学变化, 采用配对t检验分析比较患者治疗前后角膜组织学改变的差异, 以确定可反映疾病变化的观察指标。结果共聚焦显微镜特点:(1)病变区角膜上皮细胞肿胀, 细胞间出现大小不一缺损暗区, 治疗4周后细胞排列规律, 暗区变小。细胞密度治疗前后有统计学差异。(2)基底浅细胞层可见朗罕氏细胞聚集;治疗后, 朗罕氏细胞密度下降, 与治疗前相比差异显著。细胞密度在治疗后明显下降, 但仍高于正常水平。(3)疾病进展期上皮下神经纤维密度稀疏纤细;治疗后密度明显增加, 有统计学意义。(4)治疗前, 内皮细胞观察困难, 失去六边形结构, 炎性细胞浸润;治疗后, 炎性细胞减少, 可见KP, 内皮细胞密度较前增加。四项指标均在治疗前后有明显变化, 可作为辅助判断病情的指标。结论角膜内皮炎的病程中, 除了内皮层, 浅层组织也会受累, 需在病情的观察和治疗中引起注意;HRT-II的相关指标可以辅助裂隙灯所见, 了解药物治疗过程中的病理变化, 可作为指导临床角膜内皮炎药物治疗和判断预后的一种客观检查工具。

Objective To demonstrate the features and the outcomes of the Langerhans cells(LCs)during the treatment of endotheliitis by in vivo confocal mircroscopy(HRT-II).Method 32 patients diagnosed of corneal endotheliitis were involved.Changes of LCs and inflammatory cells in cornea were detected using HRT-II before and after treatment.Result HRT-II images revealed that(1)epithelium cells swelled,blurred,but they arranged more structured after 2 weeks treatment.(2)A numerous LCs presented in the anterior stromal layer and gradually abated with disease regression.(3)The density of sub-basal nerve plexus was significantly lower than that of normal,which was denser after treatment.(4)The endothelial cells could not be visualized at the beginning which recovered 7 or 14 days after treatment.Conclusion HRT-II can provide detailed histopathology proofs and appear dynamically the transformation after treatment.