共聚焦显微镜对角膜移植术后内皮型免疫排斥反应观察  

In vivo confocal microscopy features of endothelial rejection after penetrating keratoplasty

作　　者：岳文杰[1] 史伟云[2] 李素霞[1] 吕建平[3] 丁刚[1] 李姗姗[1] 

机构地区：[1]潍坊医学院,潍坊261042 [2]山东省眼科研究所,山东省眼科医院,济南250021 [3]遵义医学院,遵义563003

出　　处：《中国实用眼科杂志》2011年第4期363-367,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 应用激光共聚焦显微镜（Confocal LaserScaning Microscope,CLSM）观察角膜移植术后内皮型免疫排斥反应的特征及抗排斥治疗后的转归.方法 应用CLSM对16例角膜移植术后内皮型免疫排斥反应的病例,分别在抗排斥治疗前、治疗3～7d和1月后,对其病灶的特定位点进行检查,分析角膜上皮细胞、基质细胞、内皮细胞及免疫细胞的数量及形态学变化.结果 （1）16例患者中,8例可见典型的内皮排斥线,CLSM下：内皮排斥线是由体积较小反光明亮的炎症细胞和体积较大边界不清的异常内皮细胞构成.排斥线经过的区域上皮细胞体积增大,上皮基底层大量树突状Langerhans细胞,基质层水肿增厚,呈网格状改变.内皮细胞体积增大,边界模糊,六边形结构消失,可见多核细胞.基质水肿较重的病例,内皮层面见大量强反光团,内皮细胞无法成像.排斥线以上角膜植片相对透明的部分则各层细胞排列基本规则,内皮面少量免疫细胞附着.另8例表现为植片弥漫水肿混浊,CLSM下表现与内皮排斥线经过区域类同.（2）药物治疗3～7d后,12例患者明显好转.CLSM下见上皮基底层下树突状Langerhans细胞明显减少;基质细胞核清晰可见;内皮细胞恢复六边形结构,密度增加,其表面免疫细胞数量减少.4例患者基质层水肿减轻,中深基质层细胞有变性纤维化现象,内皮细胞层强反光团明显减少,但内皮细胞仍不能清晰成像.此4例患者用药1月后基底膜下仍有局限性树突Langerhans细胞聚集,中深基质层变性纤维化,内皮细胞排列不规则,有变圆或拉长现象.结论 应用CLSM可在细胞学水平对角膜移植术后内皮型免疫排斥反应的过程与转归进行活体的动态观察,对指导抗排斥治疗,有效提高角膜移植排斥反应的诊治水平,具有重要的临床意义.Objective To demonstrate the features and the outcomes after treatment of endothelial rejection in human corneal allograft rejection by in vivo confocal microscopy. Methods Sixteen patients with endothelium rejection ofallogratt after penetrating keratoplasty were examined by confocal microscopy, to analyze the quantity and morphological changes of corneal epithelial cells, stroma cells, endothelium cells and immune cells before treatment and 3-7days and 1 month after treatment. Results Among the 16 patients, typically endothelial rejection line were seen in 8 cases, another 8 cases＇ keratic precipitates was diffusely scattered.Confocal microscope images revealed that the endothelial rejection lines were formed by cellular aggregate of small inflammatory cells and damaged larger endothelial cells with pyknotic highly reflective nuclei. With the progression of endothelial endothelia line, epithelium cells were large in size and lose distinct boundaries, numerous Langerhans cells （LCs） were seen in the basement epithelial cell region, keratocytes were altered in appearance with increased visibility of the cytoplasm, damaged endothelial cells decreased in number, increased in size with loss of normal polygonal shape and sticked by highly reflective immune cells which scattered or gathered. In the severely edematous area, the endothelial cells were not visualized with confocal microscopy.After 3 or 7 days of treatment, 12 cases were cured. Confocal microscopy examination revealed that the density of LCs reduced gradually and normal keratocytes were detected, the endothelial cells restored to hexagon structure and the density of immune cells decreased. Endothelial cells of 4 cases still were not visualized with confocai microscopy because of the degeneration fibrosis of deep stromal layer. LCs in the basement epithelial cell region still could be found after I month of treatment, and their endothelial cells appeared elongated or rounded with loss of their normal cell junctions. Conclusions In vivo confocal micro

关 键 词：共聚焦显微镜 角膜移植 内皮排斥 

分 类 号：R779.65[医药卫生—眼科]