体内共聚焦显微镜用于评估圆锥角膜的角膜微观结构
In vivo confocal microscopy for the evaluation of corneal microstructure in keratoconus.
作者信息
Mocan Mehmet C, Yilmaz Pinar Topcu, Irkec Murat, Orhan Mehmet
机构信息
Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
出版信息
Curr Eye Res. 2008 Nov;33(11):933-9. doi: 10.1080/02713680802439219.
PURPOSE
To evaluate the corneal microstructure in keratoconus with in vivo confocal microscopy (IVCM).
METHODS
Unscarred corneas of 68 patients with keratoconus and 22 controls were evaluated with slit lamp examination, corneal topography, and IVCM (Confoscan 3.0, Vigonza, Italy). One eye was randomly chosen for analysis. Keratocyte, endothelial cell and basal epithelial densities, sub-basal and stromal nerve structure, and severity of stromal haze were evaluated.
RESULTS
Compared with corneas of control subjects, patients with keratoconus had a significantly lower anterior stromal keratocyte density (1279+/-197 cells/mm(2) vs. 1132+/-178 cells/mm(2), p=0.002), lower midstromal keratocyte density (904+/-213 cells/mm(2) vs. 770+/-120 cells/mm(2), p<0.001), lower posterior stromal keratocyte density (935+/-113 cells/mm(2) vs. 725+/-113 cells/mm(2), p<0.001), lower endothelial cell density (2924+/-300 cells/mm(2) vs. 2719+/-279 cells/mm(2), p=0.004), lower basal epithelial cell density (5987+/-699 cells/mm(2) vs. 4365+/-537 cells/mm(2), p<0.001), lower sub-basal long nerve density (32.0+/-6.5 nerves/mm(2) vs. 19.6+/-6.5 nerves/mm(2), p<0.001), thicker sub-basal (3.2+/-0.4 microm vs. 3.7+/-1.1 microm, p=0.01) and stromal nerves (5.0+/-1.2 microm vs. 8.0+/-2.9 microm, p<0.001), and higher proportion of corneas with haze (40.9% vs. 92.6%, p<0.001). A history of contact lens use (n=12) was not associated with lower keratocyte, endothelial cell, or basal epithelial cell counts.
CONCLUSIONS
Corneal microstructure is abnormal in patients with keratoconus. Keratocyte and endothelial cell loss appears to be present in keratoconic corneas.
目的
运用活体共聚焦显微镜（IVCM）评估圆锥角膜的角膜微观结构。
方法
对68例圆锥角膜患者和22例对照者的无瘢痕角膜进行裂隙灯检查、角膜地形图检查及IVCM（意大利维贡扎的Confoscan 3.0）评估。随机选取一只眼进行分析。评估角膜细胞、内皮细胞和基底上皮细胞密度、基底膜下和基质神经结构以及基质混浊的严重程度。
结果
与对照者的角膜相比，圆锥角膜患者前基质角膜细胞密度显著降低（1279±197个细胞/mm² 对 1132±178个细胞/mm²，p = 0.002），基质中层角膜细胞密度降低（904±213个细胞/mm² 对 770±120个细胞/mm²，p < 0.001），后基质角膜细胞密度降低（935±113个细胞/mm² 对 725±113个细胞/mm²，p < 0.001），内皮细胞密度降低（2924±300个细胞/mm² 对 2719±279个细胞/mm²，p = 0.004），基底上皮细胞密度降低（5987±699个细胞/mm² 对 4365±537个细胞/mm²，p < 0.001），基底膜下长神经密度降低（32.0±6.5条神经/mm² 对 19.6±6.5条神经/mm²，p < 0.001），基底膜下（3.2±0.4微米 对 3.7±1.1微米，p = 0.01）和基质神经更厚（5.0±1.2微米 对 8.0±2.9微米，p < 0.001），混浊角膜的比例更高（40.9% 对 92.6%，p < 0.001）。佩戴隐形眼镜史（n = 12）与角膜细胞、内皮细胞或基底上皮细胞计数降低无关。
结论
圆锥角膜患者的角膜微观结构异常。圆锥角膜的角膜中似乎存在角膜细胞和内皮细胞丢失。
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