Sánchez-Huerta Valeria, De Wit-Carter Guillermo, Hernández-Quintela Everardo, Naranjo-Tackman Ramón
Asociación Para Evitar la Ceguera en México, IAP, México City, México.
Cornea. 2003 Oct;22(7):604-11. doi: 10.1097/00003226-200310000-00004.
To determine the value of confocal and specular microscopy in the examination of corneal argyrosis in art silver solderers.
Six patients with corneal argyrosis underwent a complete physical and ophthalmologic examination. Specular microscopy was performed in three cases, and in vivo confocal microscopy in four cases. Ultrasound biomicroscopy and corneal topography were performed in three cases. A conjunctival specimen of one patient was examined histologically in paraffin sections.
Slit-lamp examination showed gray, diffuse opacities in the deep corneal stroma. Confocal microscopy showed highly reflective deposits with a granular pattern anterior to the corneal endothelium and hypereflective keratocyte nuclei with visible cytoplasm in the anterior stroma. Specular microscopy demonstrated round white bodies anterior to the corneal endothelium. Silver deposits were not found histologically.
Silver solderers with long-term exposure to silver compounds are at high risk of developing corneal argyrosis. We conclude that specular microscopy and in vivo confocal microscopy provided important information for the diagnosis of corneal argyrosis.
确定共焦显微镜和镜面反射显微镜在检查从事银焊工作的角膜银沉着症患者中的价值。
对6例角膜银沉着症患者进行了全面的体格和眼科检查。3例患者进行了镜面反射显微镜检查，4例患者进行了活体共焦显微镜检查。3例患者进行了超声生物显微镜检查和角膜地形图检查。对1例患者的结膜标本进行了石蜡切片组织学检查。
裂隙灯检查显示角膜深层基质有灰色弥漫性混浊。共焦显微镜检查显示角膜内皮前有高反射性沉积物，呈颗粒状，前基质中有高反射性角膜细胞细胞核，细胞质可见。镜面反射显微镜检查显示角膜内皮前有圆形白色物体。组织学检查未发现银沉积物。
长期接触银化合物的银焊工发生角膜银沉着症的风险很高。我们得出结论，镜面反射显微镜和活体共焦显微镜为角膜银沉着症的诊断提供了重要信息。
