Ciancaglini M, Carpineto P, Zuppardi E, Nubile M, Doronzo E, Mastropasqua L
Institute of Ophthalmology and Legal Medicine, University of Chieti, Chieti, Italy.
Cornea. 2001 May;20(4):368-73. doi: 10.1097/00003226-200105000-00007.
To describe the corneal findings in patients with amiodarone-induced keratopathy by means of in vivo confocal microscopy.
Twenty-two eyes of 11 patients (eight men and three women) receiving amiodarone therapy and 20 eyes of 10 healthy sex-and age-matched control subjects were selected for confocal microscopic examination. The patients were examined by use of a scanning slit corneal confocal microscope (Confoscan 2.0). Five complete scans of the entire cornea were performed for each eye with a total examination time of less than 5 minutes.
All patients receiving amiodarone showed the presence of high reflective, bright intracellular inclusions in the epithelial layers. These findings were more evident within the basal cell layers. In the eyes with advanced keratopathy (stages 2 and 3), bright microdots were detectable within the anterior and posterior stroma and on the endothelial cell layer. In the anterior stroma, the keratocyte density in the treated group was reduced compared with values of the control group (p < 0.001), and a markedly irregular aspect of the stromal nerve fibers was found. The main characteristic of this nerve irregularity was represented by the clew-shaped appearance of the nerve trunks.
Detailed examination of corneal structure by confocal microscopy shows that amiodarone keratopathy in long-term treated patients presents some findings that are consistent with higher toxicity than was expected and that involve the deep corneal layers.
通过活体共聚焦显微镜描述胺碘酮诱导的角膜病变患者的角膜表现。
选取11例接受胺碘酮治疗的患者（8例男性和3例女性）的22只眼，以及10例年龄和性别匹配的健康对照者的20只眼进行共聚焦显微镜检查。使用扫描裂隙角膜共聚焦显微镜（Confoscan 2.0）对患者进行检查。每只眼睛对整个角膜进行5次完整扫描，总检查时间少于5分钟。
所有接受胺碘酮治疗的患者上皮层均出现高反射、明亮的细胞内包涵体。这些表现以基底细胞层内更为明显。在晚期角膜病变（2期和3期）的眼中，在前、后基质层以及内皮细胞层可检测到明亮的微点。在前基质层，治疗组的角膜细胞密度低于对照组（p < 0.001），并且发现基质神经纤维明显不规则。这种神经不规则的主要特征表现为神经干呈线团状外观。
共聚焦显微镜对角膜结构的详细检查表明，长期接受治疗的患者的胺碘酮角膜病变呈现出一些与预期更高毒性相符的表现，且累及角膜深层。
