玻璃体视网膜手术硅油填充后角膜细胞形态学改变的激光共焦显微镜观察  

Morphological changes of cornea in eyes after vitreoretinal surgery and silicone oil tamponade observed by in vivo laser scanning confocal microscopy

作　　者：王健[1] 陈松[1] 

机构地区：[1]天津医科大学眼科临床学院 天津市眼科医院 天津市眼科学与视觉科学重点实验室 天津市眼科研究所,天津300020

出　　处：《中国实用眼科杂志》2016年第8期801-804,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的应用激光共焦显微镜观察视网膜脱离患者玻璃体视网膜手术硅油填充后角膜细胞形态学改变，探讨激光共焦显微镜在早期发现硅油相关的角膜病变中的意义。方法采用前瞻性病例对照研究。选取2011年5月至2014年5月在天津市眼科医院，应用激光共聚焦显微镜对角膜内皮细胞密度、角膜厚度、基底上皮下神经纤维数量及其他各层细胞的形态学改变进行观察记录。观察视网膜脱离患者57例（57只眼），均在局麻下行保留晶状体玻璃体切割手术，其中根据是否眼内填充硅油分为硅油填充组29例（29只眼）和对照组28例（28只眼）。分别于手术前、手术后三个月对术眼进行激光共聚焦显微镜检查，记录相关数据。结果激光共焦显微镜显示硅油填充组术后角膜上皮细胞层出现不规则形反光增强颗粒，基底上皮下神经数量有所减少，前基质内出现形态异常的神经纤维，基质层内可见高反光的白色小点，角膜内皮细胞形态存在不同程度的异形性，内皮细胞密度有显著的下降，角膜厚度无明显变化。结论在保留晶状体的玻璃体视网膜手术中，硅油填充后角膜的共焦显微镜图像的改变早于临床表现，激光共焦显微镜是早期发现硅油填充术后角膜形态学改变中的一个重要手段。Objective To evaluate the morphological changes in the cornea by in vivo laser scanning confocal microscopy （LSCM） after vitreoretinal surgery and silicone oil （SO） endotamponade and to explore the value of LSCM in the early detection of silicone related keratopathy. Methods This prospective comparative consecutive case-control study evaluated the corneal morphological changes of 29 SO filled vitrectomizied eyes （case group） as compared to 28 vitrectomizied eyes without SO injection （control group）. The density of corneal endothelial cells, corneal thickness, the number of sub epithelial nerve fibers and other morphological changes of the cornea were observed by LSCM preoperatively and 3 months after surgery and were compared between the two groups. Results After SO tamponade, corneal epithelial cells appeared round or irregular-shaped enhance reflection particles, sub epithelial nerve appeared thin, curved, spiral-shaped and other abnormal patterns. The number of sub epithelial nerve decreased, there were small, intensive, high-reflectivewhite spots in the corneal stroma, the varied corneal endothelial cell morphology showed that the high-reflective particles, the endothelial cells＇ density decreased significantly, no significant changes in corneal thickness. Conclusions In patients with SO tamponade after vitrectomy reserve lens, LSCM imaging reveals early morphological alterations of the cornea before their clinical manifestation. In vivo LSCM is a useful tool in the early detection of corneal abnormalities caused by SO injection.

关 键 词：角膜 视网膜脱离 玻璃体视网膜手术 硅油 共焦显微镜 

分 类 号：R454.2[医药卫生—治疗学]