Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Ophthalmology. 2013 Jul;120(7):1348-53. doi: 10.1016/j.ophtha.2012.12.038. Epub 2013 Mar 15.
To investigate in vivo corneal changes of keratoneuritis in early stage Acanthamoeba keratitis (AK) using in vivo laser confocal microscopy.
Single-center, prospective, clinical study.
Thirteen eyes (12 patients; 5 men and 7 women; mean age ± standard deviation, 22.3 ± 4.2 years) with keratoneuritis resulting from early stage AK were included in this study.
In vivo laser confocal microscopy was performed, paying special attention to keratoneuritis.
Selected confocal images of corneal layers were evaluated qualitatively for shape and degree of light reflection of abnormal cells and deposits.
In all patients, Acanthamoeba cysts were observed clearly in the basal epithelial cell layer as highly reflective round particles with a diameter of 10 to 20 μm. Bowman's layer infiltration of Acanthamoeba cysts was observed in only 1 case, and no cases showed stromal or nerve infiltration of Acanthamoeba cysts. In the stroma, all cases showed highly reflective activated keratocytes forming a honeycomb pattern; these changes were significant around the keratoneuritis. Infiltration of inflammatory cells, possibly polymorphonuclear cells, was observed along with keratocyte bodies in all cases. Numerous highly reflective spindle-shaped materials were observed around the keratoneuritis. Most notably, highly reflective patchy lesions were observed around the keratoneuritis in 11 cases (84.6%). Inflammatory cells also were observed in the endothelial cell layer in 4 cases (30.8%).
In vivo laser confocal microscopy identified consistent corneal abnormalities around keratoneuritis in early stage AK patients, of which highly reflective patchy lesions may be characteristic of keratoneuritis. Further morphologic studies of corneas with early stage AK in a larger number of patients may elucidate the clinical significance of radial keratoneuritis and may help us to understand the interaction between Acanthamoeba organisms and host corneal cells or nerves.
利用活体激光共聚焦显微镜观察早期棘阿米巴角膜炎（AK）中神经角膜病变的活体角膜变化。
单中心、前瞻性临床研究。
本研究共纳入 13 只眼（12 例患者；5 男 7 女；平均年龄±标准差，22.3±4.2 岁），均为早期 AK 所致神经角膜病变。
进行活体激光共聚焦显微镜检查，特别注意神经角膜病变。
对角膜各层的选定共焦图像进行定性评估，观察异常细胞和沉积物的形状和光反射程度。
所有患者均在基底上皮细胞层清晰观察到棘阿米巴包囊，呈直径 10 ～ 20μm 的高反射性圆形颗粒。仅 1 例患者观察到 Bowman 层棘阿米巴包囊浸润，无病例出现棘阿米巴包囊基质或神经浸润。在基质中，所有病例均显示高度反射性激活的角膜细胞形成蜂窝状图案；这些变化在神经角膜病变周围非常明显。在所有病例中，均观察到炎症细胞（可能为多形核白细胞）浸润，伴有角膜细胞体。在神经角膜病变周围观察到大量高度反射性梭形物质。最值得注意的是，11 例（84.6%）患者在神经角膜病变周围观察到高度反射性斑片状病变。在 4 例（30.8%）患者中也观察到内皮细胞层中有炎症细胞。
活体激光共聚焦显微镜可识别早期 AK 患者神经角膜病变周围一致的角膜异常，其中高度反射性斑片状病变可能是神经角膜病变的特征。对更多数量的早期 AK 角膜进行进一步的形态学研究，可能阐明放射状神经角膜病变的临床意义，并有助于我们了解棘阿米巴生物体与宿主角膜细胞或神经之间的相互作用。
