Holopainen Juha M, Moilanen Jukka A O, Tervo Timo M T
Department of Ophthalmology, University of Helsinki, PO Box 220, 00029 HUS, Finland.
Cornea. 2003 Mar;22(2):160-3. doi: 10.1097/00003226-200303000-00016.
To assess the value of in vivo confocal microscopy (CM) in the diagnosis of Fleck dystrophy and pre-Descemet's membrane corneal dystrophy.
Case report of two patients. Standard slit-lamp and ophthalmic examination and in vivo CM were performed on both patients. The thickness of the cornea and the morphology of the corneal epithelium, stroma, endothelium, and subbasal nerves were evaluated by confocal microscopy.
Biomicroscopy revealed bilateral, fine, dust-, and flour-like opacities in the corneal stroma for the Fleck dystrophy patient. In the pre-Descemet's membrane corneal dystrophy patient, biomicroscopy showed opacities larger than those in the first patient. Both patients were then examined by in vivo CM. Confocal microscopy of the Fleck dystrophy showed intracellular deposits throughout the stroma. In pre-Descemet's membrane corneal dystrophy, however, these and the extracellular deposits were observed immediately anterior to Descemet's membrane. The thicknesses of the corneas were 560 and 650 microm for Fleck and pre-Descemet's membrane corneal dystrophy, respectively. The surface epithelium, subbasal nerves, and endothelium showed normal morphology in both patients.
In vivo CM is a valuable tool in diagnosing rare corneal dystrophies when the final diagnosis is difficult to obtain with conventional methods.
评估活体共聚焦显微镜（CM）在诊断斑点状角膜营养不良和前弹力层下角膜营养不良中的价值。
两名患者的病例报告。对两名患者均进行了标准裂隙灯和眼科检查以及活体共聚焦显微镜检查。通过共聚焦显微镜评估角膜厚度以及角膜上皮、基质、内皮和基底膜下神经的形态。
生物显微镜检查显示，斑点状角膜营养不良患者的角膜基质有双侧、细小、粉尘样和面粉样混浊。在前弹力层下角膜营养不良患者中，生物显微镜检查显示混浊比第一名患者的更大。然后对两名患者进行了活体共聚焦显微镜检查。斑点状角膜营养不良的共聚焦显微镜检查显示整个基质内有细胞内沉积物。然而，在前弹力层下角膜营养不良中，这些沉积物以及细胞外沉积物在Descemet膜前方紧邻处被观察到。斑点状角膜营养不良和前弹力层下角膜营养不良患者的角膜厚度分别为560微米和650微米。两名患者的表面上皮、基底膜下神经和内皮均显示正常形态。
当常规方法难以做出最终诊断时，活体共聚焦显微镜是诊断罕见角膜营养不良的一种有价值的工具。
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