共焦显微镜对翼状胬肉及其周围角膜的组织病理学观察  

In vivo confocal microscopy of cornea in patients with pterygium

作　　者：茅晓红[1] 胡楠[1] 吴玉宇[1] 程争平[1] 

机构地区：[1]南通大学附属医院眼科,226001

出　　处：《中华眼视光学与视觉科学杂志》2012年第11期691-694,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的探讨角膜共焦显微镜下翼状胬肉及其周围角膜的组织病理学和细胞学特征。方法前瞻性自身对照研究。单眼初发性翼状胬肉患者40例，应用角膜共焦显微镜观察胬肉形态，对侧无胬肉眼为对照。记录翼状胬肉、中央角膜、翼状胬肉周边角膜各层细胞图像，并对各层细胞形态、密度的结果采用配对t检验进行分析。结果共焦显微镜下翼状胬肉的表层细胞胞体发亮，边界发暗，胬肉基质中可见毛细血管内血流，有时可见内含小圆形细胞的微囊样结构及Langerhans细胞。翼状胬肉周边角膜翼状上皮细胞、基底上皮细胞形态不规则，部分被拉长并扭曲；中央及周边各层上皮细胞平均密度小于对照眼（t=-3．92、-3．55、-3．36、-2．61、-4．31、-4．11，P均〈0．05）；翼状胬肉眼角膜上皮下Langerhans细胞平均密度大于对照眼（t=3．75、4．23，P均〈0．05）；角膜上皮基底细胞层下神经纤维比较杂乱，神经弯曲度大（t=5．02。P〈0．01），分支多（t=2．51，P〈0．05）。结论共焦显微镜可观察到翼状胬肉细胞水平的特征。翼状胬肉患者胬肉周边角膜上皮细胞、上皮下Langerhans细胞、上皮基底细胞层下神经、前基质细胞及角膜厚度均有变化。Objective To study the histopathologic and cellular alteration of the cornea in patients with pterygium using in vivo confoeal microscopy. Methods It was a prospective self-control study. Forty patients with unilateral primary pterygium were examined with the HeidelBerg retina tomograph （HRT II ）/Rostock cornea module （RCM）. The patients＇s contralateral eye without pterygium was used as the control. The analysis included the examination of the typical pterygium structure, and the quantitative assessment of the morphological changes of the epithelium, subbasal nerves, stroma and endothelium of the adjacent cornea. Data were compared with a paired t test. Results Under con.focal microscopy, the superficial ceils of the pterygium appeared as hyper-reflective cytoplasm with less bright cell borders. Small capillaries, Langerhans cells （LCs） and microcysts containing hyper-reflective round cells could be observed occasionally. Morphological changes were noted in intermediate cells and basal cells of the epithelium at the peripheral cornea adjacent to the pterygium. The density of epithelial cells and anterior stromal cells was significantly reduced more in the diseased eye than in the control eye （t=-3.92, -3.55, -3.36, -2.61, -4.31, -4.11, P〈0.05）. The number of LCs at the peripheral cornea adjacent to the pterygium was significantly increased compared to the control eye （t=3.75, 4.23, P〈0.05）. The sub-basal nerves at central cornea of pterygium were mess with much tortuosity （t=5.02, P〈0.01） and branch （t=2.51, P〈0.05）. Conclusion In vivo confocal microscopy can observe significant alterations in cell density, cell morphology, and the appearance of the sub-epithelial nerve plexus of the central and peripheral cornea of pterygium.

关 键 词：翼状胬肉 角膜 共焦显微镜 组织学 

分 类 号：R777.33[医药卫生—眼科]