Rokita-Wala I, Mrukwa-Kominek E, Gierek-Ciaciura S
Z I Katedry i Kliniki Okulistyki Slaskiej AM w Katowicach.
Klin Oczna. 2000;102(5):339-44.
The study aimed to in vivo evaluate corneal structure in Fuchs' dystrophy.
Forty-two eyes of 21 patients (11 women and 10 men) aged 34-80 (mean 60.8) were studied. Sixteen patients presented clinical symptoms. The cornea was examined using a Confoscan P4 scanning slit confocal microscope (Tomey). Before examination, the cornea was anesthetized with 0.5% propacaine (Alcaine, Alcon) in order to inhibit the corneopalpebral reflex. A 40x microscope objective was covered with a drop of polyarylic acid gel (Vidisic, Mann Pharma) and then it was moved horizontally close to the patient's cornea and the examination was carried out.
In the early stage of Fuchs dystrophy, slit biomicroscopy revealed fine dark spots within the corneal endothelium, while in the advanced stage the cornea had the appearance of beaten metal. On confocal microscopy, there were diffused hyporeflective areas in the early-stage disease. The endothelial cells located beyond these areas were pleomorphic and polymegathic. In the late stage we observed diffused hyporeflective areas surrounded by hyperreflective endothelial cells, which could not be analyzed separately. Within the corneal stroma, the collagen fibers were blurred and the background illumination was increased. In the posterior part of the stroma, dark bands were seen. The epithelium contained cystic structures (blisters). The membranes of the basal cells were thickened and the background illumination was increased.
Confocal microscopy allows to diagnose Fuchs dystrophy and visualize endothelial cells within the swollen cornea.
本研究旨在对Fuchs角膜内皮营养不良的角膜结构进行体内评估。
对21例患者（11名女性和10名男性）的42只眼睛进行了研究，患者年龄在34 - 80岁之间（平均60.8岁）。16例患者有临床症状。使用Confoscan P4扫描裂隙共聚焦显微镜（多美）对角膜进行检查。检查前，用0.5%丙美卡因（爱尔卡因，爱尔康）对角膜进行麻醉，以抑制角膜眼睑反射。用一滴聚丙烯酸凝胶（维迪西，曼恩制药）覆盖40倍显微镜物镜，然后将其水平移近患者角膜并进行检查。
在Fuchs角膜内皮营养不良的早期，裂隙生物显微镜检查显示角膜内皮内有细小的黑点，而在晚期角膜呈现出 beaten metal的外观。在共聚焦显微镜下，疾病早期有弥漫性低反射区。位于这些区域之外的内皮细胞呈多形性和大小不均一性。在晚期，我们观察到由高反射性内皮细胞包围的弥漫性低反射区，无法单独分析。在角膜基质内，胶原纤维模糊，背景照明增加。在基质后部可见暗带。上皮细胞含有囊性结构（水泡）。基底细胞膜增厚，背景照明增加。
共聚焦显微镜检查可用于诊断Fuchs角膜内皮营养不良，并观察肿胀角膜内的内皮细胞。
