蚕蚀性角膜溃疡组织病理学的观察  

Histopathological study on Mooren’s ulcer

作　　者：赵长霖[1] 谢汉平[1] 陈代伦[2] 

机构地区：[1]第三军医大学西南医院全军眼科中心,重庆400038 [2]第三军医大学中心实验室,重庆400038

出　　处：《第三军医大学学报》2005年第23期2366-2369,共4页Journal of Third Military Medical University

摘　　要：目的观察蚕蚀性角膜溃疡角膜、邻近球结膜的组织病理和超微病理特点。方法将手术切下的角膜缘角膜、进行缘角膜、邻近球结膜组织制备成石蜡切片和超薄切片,分别在光镜和透射电镜下观察组织病理变化和超微结构变化。以Terrien角膜边缘变性的角结膜组织、细菌性角膜溃疡的角膜组织作对照。结果蚕蚀性角膜溃疡的球结膜、巩膜中存在以淋巴细胞、浆细胞浸润为主的慢性免疫炎症反应;角膜缘处角膜上皮、前弹力膜、前基质层、邻近表层巩膜溶解消失,残存的基质层胶原结构紊乱;溃疡进行缘的角膜上皮基底膜结构破坏消失。Terrien角膜边缘变性的球结膜及角膜上皮内可见淋巴细胞浸润;角膜上皮基底膜正常;前弹力层自下向上破坏变薄。在细菌性角膜溃疡病变与正常组织交界处,基底膜未见改变。结论蚕蚀性角膜溃疡的球结膜可能起着局部淋巴结作用。溃疡进行缘的角膜上皮基底膜首先被侵蚀,提示患者的基底膜可能存在异常,需要进一步研究。Objective To observe the histopathologic and ultrastructural characteristics of cornea and adjacent conjunctiva in Mooren＇ s ulcer. Methods The samples of limbal and central cornea and adjacent bulbar conjunctiva taken from active Mooren＇ s ulcer after lamellar keratoplasty were cut into paraffin sections and ultrathin sections and observed by light and transmission electron microscopy. The samples taken from patients of a Terrien＇s marginal degeneration and a bacterial corneal ulcer were used as controls. Results Chronic inflammation including lymphocytes and plasma cells infiltrating existed in bulbar conjunctiva and sclera of Mooren＇ s ulcer. Limbal corneal epithelium, Bowman＇ s membrane, anterior stroma and adjacent superficial sclera melted and the inferior stromal collagen disorganized. The epithelial basement membrane of ulcer progressive edge had been destroyed while the epithelium and stroma kept quiescent. Lymphocytes infiltrated in con- junctiva and corneal epithelium of Terrien＇ s marginal degeneration with normal epithelial basement membrane, while Bowman＇ s membrane was destroyed. The epithelial basement membrane of bacterial corneal ulcer was intact. Conclusion Bulbar conjunctiva may act as a local lymph node of Mooren＇ s ulcer. Epithelial basement membrane of Mooren＇ s ulcer may have some abnormality as it was invaded first during ulcer progressing and it＇ s valuable tO have a further study.

关 键 词：角膜溃疡 组织病理学 超微结构 石蜡切片 超薄切片 

分 类 号：R322.91[医药卫生—人体解剖和组织胚胎学] R772.2[医药卫生—基础医学]