共焦显微镜在不典型虹膜角膜内皮综合征诊断中应用  

Confocal microscopy used as the definitive diagnostic method in atypical iridocorneal endothelial syndrome

作　　者：胡蓉蓉[1] 顾扬顺[1] 李修义[1] 汪晓宇[1] 

机构地区：[1]浙江大学医学院附属第一医院眼科,杭州310003

出　　处：《中国实用眼科杂志》2009年第4期416-419,共4页Chinese Journal of Practical Ophthalmology

基　　金：浙江省科技厅科技攻关项目（2006C23034）

摘　　要：目的探讨共焦显微镜检查在虹膜角膜内皮综合征临床诊断中的应用价值。方法对8例（其中6例单眼患病，2例双眼患病）常规检查无法确诊的疑似虹膜角膜内皮综合征病例进行共焦显微镜检查，观察角膜内皮层病变结构。结果活体共焦显微镜检查发现患眼角膜内皮细胞均偏大而且形状不规则，细胞核反光明显增高，可见散在双核、多核、偏位核及分叶核等改变，7例细胞边界模糊，部分病例有局灶内皮细胞缺失、胞内环形暗区、分裂状细胞等改变。此外，3例单眼患病病例的对侧眼在共焦显微镜下发现内皮细胞密度下降、大小不均等改变。最后确诊为原发性进行性虹膜萎缩型2例、Chandler综合征4例、Cogan—Reese综合征2例。结论共焦显微镜可以在细胞水平上无刨、高分辨率地观察到虹膜角膜内皮综合征患眼角膜内皮层特征性的显微结构改变，且不受角膜水肿的影响，大大提高了虹膜角膜内皮综合征诊断的准确性，并有助于早期诊断，具有很高的应用价值。Objective To discuss the diagnostic potential of confocal microscopy for iridocomeal endothelial（ICE）syndrome.Methods Eight patients（six patients unilaterally involved and two patients bilaterally involved）of suspected ICE syndrome, which can＇t be diagnosed with conventional examination,were collected.The corneal endothelium of all eight patients were detailedly investigated by confocal microscopy.Results In-vivo confocal microscopy highlighted larger and irregularly shaped endothelial cells with marked hyperreflective nuclei in all eight patients and indistinct cellular borders in seven patients.Cells with two or more nuclei,nuclei with sublobes or adjacent to the cellular borders could be found.Several patients exhibited local loss of endothelial cells, ring-shaped dark area in the cells, cells appearing during the division phase, and so on. The contralateral eyes in 3 patients with unilateral ICE syndrome exhibited lower endothelial cell density and less homogenieity in cellular size.According to confocal microscopy,the eight patients were diagnosed as two cases of progressive essential iris atrophy, four cases of Chandler＇ s syndrome and two cases of Cogan Reese syn- drome.Conclusion Confocal microscopy,which allows the hurtless evaluation of the corneal endothelium at the cellular level,can be used as the definitive, early diagnostic method in ICE syndrome, despite the presence of corneal edema.The technique has great potential for diagnosing ICE syndrome, especially for the atypical cases.

关 键 词：虹膜角膜内皮综合征 共焦显微镜 角膜内皮 

分 类 号：R773.1[医药卫生—眼科] R772.21[医药卫生—临床医学]