Mustonen R K, McDonald M B, Srivannaboon S, Tan A L, Doubrava M W, Kim C K
Refractive Surgery Center of the South, EENT Institute at Memorial Medical Center, New Orleans, Louisiana, USA.
Cornea. 1998 Sep;17(5):493-503. doi: 10.1097/00003226-199809000-00006.
The purpose of this study is to analyze in vivo confocal microscopic findings of corneas with Fuchs' endothelial dystrophy.
Central corneas of 17 eyes of 11 patients aged 41-86 years were examined using in vivo scanning slit confocal microscopy after being diagnosed with Fuchs' endothelial dystrophy. The cellular structure of the corneas was analyzed morphologically and quantitatively and compared to control results from 22 healthy corneas.
Bullae were detected in the basal epithelial layer of one eye. Eight of 17 eyes (47%) exhibited an abnormal Bowman's layer: diffuse bright reflection and absence of nerves. Eleven eyes (65%) exhibited abnormal anterior stroma: lacunae and diffuse increased light reflection due to edema. In 12 eyes (71%), lacunae or dark bands 5-20 microm wide against increased background reflection were noted in the posterior stroma. Descemet's membrane was thickened in all eyes. Dark bands were detected in six eyes (35%). Guttae (137-1,231/mm2) 20-40 microm in diameter were found in every endothelial cell layer. The mean endothelial cell count was 1,202 +/- 850 (cells/mm2 +/- SD; range, 0-2,735). There was a positive correlation between endothelial cell counts obtained by specular microscopy and those obtained by confocal microscopy (r = 0.95).
In vivo confocal microscopic findings of Fuchs' endothelial dystrophy are described for the first time in a series of cases. Pathological changes in Fuchs' dystrophy were detected in all corneal layers, more frequently in the posterior layers. Endothelial cell counts obtained with confocal microscopy were statistically similar to those obtained with standard specular microscopy.
本研究旨在分析富克斯内皮营养不良角膜的活体共聚焦显微镜检查结果。
对11例年龄在41 - 86岁患者的17只眼睛的中央角膜进行活体扫描裂隙共聚焦显微镜检查，这些眼睛均被诊断为富克斯内皮营养不良。对角膜的细胞结构进行形态学和定量分析，并与22只健康角膜的对照结果进行比较。
在一只眼睛的基底上皮层检测到水泡。17只眼睛中有8只（47%）显示Bowman层异常：弥漫性明亮反射且无神经。11只眼睛（65%）显示前基质异常：由于水肿出现腔隙和弥漫性光反射增加。在12只眼睛（71%）中，后基质出现5 - 20微米宽的腔隙或暗带，背景反射增强。所有眼睛的Descemet膜均增厚。6只眼睛（35%）检测到暗带。在每个内皮细胞层均发现直径为20 - 40微米的滴状物（137 - 1231个/平方毫米）。平均内皮细胞计数为1202±850（细胞/平方毫米±标准差；范围为0 - 2735）。镜面显微镜检查获得的内皮细胞计数与共聚焦显微镜检查获得的计数之间存在正相关（r = 0.95）。
首次在一系列病例中描述了富克斯内皮营养不良角膜的活体共聚焦显微镜检查结果。富克斯营养不良的病理变化在所有角膜层均有发现，在后层更为常见。共聚焦显微镜检查获得的内皮细胞计数与标准镜面显微镜检查获得的计数在统计学上相似。
