Le Qi-Hua, Sun Xing-Huai, Xu Jian-Jiang
Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.
Int Ophthalmol. 2009 Feb;29(1):11-8. doi: 10.1007/s10792-007-9187-x. Epub 2008 Feb 23.
We carried out a study by in-vivo confocal microscopy to investigate the appearance of iridocorneal endothelial (ICE) syndrome, and discuss its diagnostic potential.
Twelve patients, each with unilateral ICE syndrome, had both their eyes examined by in-vivo confocal microscopy. The images were recorded and analyzed by the use of proprietary software. Endothelium density, average endothelial area, coefficient of variation of cell size, percentage of hexagonal cells, and nerve fiber diameter were measured in both the anterior and posterior stroma. Corneal thickness was also measured for both eyes. A non-parametric test was used to compare differences between the affected eye and the contralateral healthy one.
In-vivo confocal microscopy highlighted two main patterns of abnormal "epithelioid-like" endothelium, both characterized by marked hyperreflective nuclei and loss of regularity in cellular size and shape. The first pattern was relatively regular cell size and shape, conserving a pattern similar to that of normal endothelial cells. However, the cells lost normal hexagonality and presented prominent uniform "cobblestone-like" nuclei occupying the central area of the cells. The second type was more irregular in cellular size and shape, with hyperreflective diversely shaped nuclei adjacent to the boundaries of the cells. Cells with two nuclei could be found in both types. Compared with the contralateral eye, the stromal nerve fibers in affected eyes were unusually thicker and distorted. Nerve diameters in the anterior stroma of affected eyes and contralateral eyes were 5.7 +/- 0.5 microm and 3.2 +/- 0.2 microm, respectively; those in the posterior stroma were 10.8 +/- 0.3 microm and 6.6 +/- 0.4 microm, respectively (both P < 0.001).
Application of confocal microscopy indicates that ICE syndrome is characterized by pleomorphic epithelioid-like endothelial cells with hyperreflective nuclei. The technique has great potential in diagnosing ICE syndrome, especially in cases with corneal edema.
我们通过活体共聚焦显微镜进行了一项研究，以观察虹膜角膜内皮（ICE）综合征的表现，并探讨其诊断潜力。
12例单侧ICE综合征患者的双眼均接受了活体共聚焦显微镜检查。使用专用软件记录并分析图像。测量前后基质中的内皮细胞密度、平均内皮细胞面积、细胞大小变异系数、六边形细胞百分比和神经纤维直径。同时测量双眼的角膜厚度。采用非参数检验比较患眼与对侧健眼之间的差异。
活体共聚焦显微镜突出显示了两种主要的异常“上皮样”内皮细胞模式，其特征均为细胞核显著高反射以及细胞大小和形状失去规则性。第一种模式中细胞大小和形状相对规则，保留了与正常内皮细胞相似的模式。然而，细胞失去了正常的六边形形态，呈现出占据细胞中心区域的突出且均匀的“鹅卵石样”细胞核。第二种类型的细胞大小和形状更不规则，在细胞边界附近有高反射的形状各异的细胞核。两种类型中均可发现双核细胞。与对侧眼相比，患眼的基质神经纤维异常增粗且扭曲。患眼前基质和对侧眼前基质的神经直径分别为5.7±0.5微米和3.2±0.2微米；后基质中的神经直径分别为10.8±0.3微米和6.6±0.4微米（均P<0.001）。
共聚焦显微镜的应用表明，ICE综合征的特征是具有高反射细胞核且多形性的上皮样内皮细胞。该技术在诊断ICE综合征方面具有很大潜力，尤其是在角膜水肿的病例中。
