Grupcheva C N, Craig J P, Sherwin T, McGhee C N
Discipline of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
Clin Exp Ophthalmol. 2001 Jun;29(3):133-7. doi: 10.1046/j.1442-9071.2001.00393.x.
The purpose of this study was to demonstrate microstructural differences between clinically similar, but aetiologically different, cases of corneal oedema in four subjects. In vivo confocal microscopy highlighted oedema of the basal epithelium, prominent nerve-keratocyte interactions, and typical 'epithelialization' of the endothelium in a case of iridocorneal endothelial syndrome; however, a similar microstructural appearance was observed in a case of presumed herpetic disciform keratitis. The latter diagnosis was subsequently revised on this basis. Confocal examination of Fuchs' endothelial dystrophy demonstrated oedema of the basal epithelium, prominent wing cells, anterior stromal alterations, fibrosis of Descemet's membrane and a typical 'strawberry' appearance of the endothelium. In contrast, in vivo microstructural examination of bilateral keratoconus with hydrops confirmed oedema mainly involving the epithelium and anterior stroma. In vivo confocal microscopy allows the clinician to observe the living cornea at a microstructural level and to better diagnose and differentiate borderline or unusual cases of corneal oedema.
本研究的目的是展示四名受试者中临床症状相似但病因不同的角膜水肿病例之间的微观结构差异。在体内共聚焦显微镜检查中，虹膜角膜内皮综合征病例显示基底上皮水肿、显著的神经 - 角膜细胞相互作用以及内皮典型的“上皮化生”；然而，在一例疑似疱疹性盘状角膜炎病例中也观察到了类似的微观结构表现。后者的诊断随后在此基础上进行了修订。对富克斯内皮营养不良的共聚焦检查显示基底上皮水肿、显著的翼状细胞、前基质改变、Descemet膜纤维化以及内皮典型的“草莓”外观。相比之下，对双侧圆锥角膜伴角膜膨隆的体内微观结构检查证实水肿主要累及上皮和前基质。体内共聚焦显微镜检查使临床医生能够在微观结构水平观察活体角膜，并更好地诊断和鉴别角膜水肿的临界或不寻常病例。
