[共焦显微镜下虹膜角膜内皮综合征角膜的形态学改变]

LE Qi-hua, Xu Jian-jiang, Sun Xing-huai, Zheng Tian-yu

Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.

Zhonghua Yan Ke Za Zhi. 2008 Nov;44(11):987-92.

OBJECTIVE

To evaluate the morphological changes of cornea in iridocorneal endothelial syndrome (ICE) under the examination of in vivo confocal microscopy.

METHODS

The experimental design was retrospective observation case series. Twenty-three eyes of 23 consecutive patients, each diagnosed as ICE, had their both eyes examined with the in vivo confocal microscopy (NIDEK, confoscan 3.0). The images were recorded and analyzed by software NAVIS. Measurements were performed on endothelium density, average endothelial area, the percentage of hexagonal cells and the percentage of endothelium with nuclei, and the ANOVA was done to assess the differences.

RESULTS

In vivo confocal microscopy highlighted two main patterns of endothelial changes: "kite-like" and "epithelial-like" abnormal endothelium, characterised by marked hyperreflective nuclei and loss of regularity in cellular size and shape. With the progression of disease, the endothelium density and the percentage of hexagonal endothelial cells decreased, which were (1687.1 +/- 122.6), (1210.6 +/- 168.7), (947.3 +/- 145.2), (856.8 +/- 73.4) cells/mm2 and (51.5 +/- 6.3)%, (39.8 +/- 9.2)%, (32.7 +/- 8.1)%, (24.1 +/- 5.6)% respectively in detail. In contrast, the average endothelial area the percentage of endothelium with nuclei increased, which were (678.3 +/- 56.3), (928.7 +/- 96.2), (1188.5 +/- 72.6), (1337.5 +/- 60.8) microm2 and (12.6 +/- 1.4)%, (56.8 +/- 3.7)%, (78.7 +/- 5.6)%, (84.3 +/- 2.8)%. The differences all had statistical significance (F = 7.158, 7.736, 6.876, 14.452 respectively, P = 0.000). The morphology of keratocyte and endothelium were normal, compared with the contralateral healthy eyes. However, the stromal nerves became thicker and more tortuous with the disease advancement.

CONCLUSIONS

The application of confocal microscopy indicates that the ICE is characterised by epithelial-like endothelial cells with hyperreflective nuclei. The technique has great potential in diagnosing ICE, especially in evaluating the disease progression.

目的

通过活体共聚焦显微镜检查评估虹膜角膜内皮综合征（ICE）中角膜的形态学变化。

方法

实验设计为回顾性观察病例系列。连续23例确诊为ICE的患者的23只患眼均接受了活体共聚焦显微镜（NIDEK，confoscan 3.0）检查。图像由NAVIS软件记录并分析。测量内皮细胞密度、平均内皮细胞面积、六边形细胞百分比以及有核内皮细胞百分比，并进行方差分析以评估差异。

结果

活体共聚焦显微镜突出显示了两种主要的内皮细胞变化模式：“风筝样”和“上皮样”异常内皮细胞，其特征为细胞核明显高反射以及细胞大小和形状失去规则性。随着疾病进展，内皮细胞密度和六边形内皮细胞百分比降低，具体分别为（1687.1±122.6）、（1210.6±168.7）、（947.3±145.2）、（856.8±73.4）个细胞/mm²和（51.5±6.3）%、（39.8±9.2）%、（32.7±8.1）%、（24.1±5.6）%。相比之下，平均内皮细胞面积和有核内皮细胞百分比增加，分别为（678.3±56.3）、（928.7±96.2）、（1188.5±72.6）、（1337.5±60.8）μm²和（12.6±1.4）%、（56.8±3.7）%、（78.7±5.6）%、（84.3±2.8）%。差异均具有统计学意义（F分别为7.158、7.736、6.876、14.452，P = 0.000）。与对侧健康眼相比，角膜细胞和内皮细胞的形态正常。然而，随着疾病进展，基质神经变得更粗且更弯曲。