Stevens-Johnson综合征和中毒性表皮坏死松解症慢性期眼表活体共聚焦显微镜观察  

In vivo confocal microscopic observation of corneal changes in patients with chronic Stevens-Johnson syndrome or toxic epidermal necrolysis

作　　者：高婷婷[1] 李莹[1] 刘洁[2] 龙琴[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730 [2]中国医学科学院北京协和医学院北京协和医院皮肤科,100730

出　　处：《中华眼科杂志》2017年第3期177-181,共5页Chinese Journal of Ophthalmology

摘　　要：目的 应用眼表活体共聚焦显微镜观察Stevens-Johnson综合征和中毒性表皮坏死松解症慢性期患者眼角膜变化特点.方法 回顾性病例研究.连续选择2014年3月至2015年4月就诊于北京协和医院眼科门诊的11例（22只眼）慢性期Stevens-Johnson综合征和中毒性表皮坏死松解症患者,其中男性5例,女性6例,平均年龄为（51.4±12.9）岁.对所有患者进行裂隙灯检查、睑板腺照相,并采用眼表活体共聚焦显微镜检查患者角膜各层形态.结果 10例SJS/TEN慢性期患者并发干眼伴睑板腺功能障碍（19只眼,占86.4％）,2例患者视力严重下降（3只眼,占13.6％）,伴角膜新生血管形成和角膜结膜化,1例患者双眼病变严重程度不一致.IVCM下,86.4％的SJS/TEN慢性期患者（10例,19只眼）角膜上皮细胞呈激活状态,91％的患者（10例,20只眼）角膜神经失去正常形态和分布,所有患者（11例,22只眼）角膜基质层可见一定比例呈激活状态的基质细胞,86.4％的患者（10例,19只眼）角膜内皮层形态大致正常,13.6％的患者（2例,3只眼）角膜缘Vogt栅栏萎缩,角膜新生血管形成,45.5％的患者（5例,10只眼）角膜基底层下神经丛水平可见朗格汉斯细胞浸润,27.3％的患者（3例,6只眼）角膜上皮层和角膜基质层中散在炎症细胞浸润.结论 SJS和TEN慢性期患者伴发的角膜上皮细胞形态变化明显,角膜神经失去正常分布,角膜基质细胞呈激活状态.眼表活体共聚焦显微镜对SJS/TEN慢性期眼部并发症的随访和疗效评估具有重要意义.Objective To describe corneal alterations visible on in vivo confocal microscopy in patients with debilitating ocular sequelae caused by Stevens-Johnson syndrome （SJS） or toxic epidermal necrolysis （TEN）.Methods Twenty-two eyes of 11 consecutive patients suffering from chronic SJS or TEN were studied using slit lamp and in vivo confocal microscopy in the Ophthalmology Outpatient Department of Peking Union Medical College Hospital from March 2014 to April 2015.Results Dry eye with meibomian gland dysfunction （19 eyes of 10 patients,86.4%） was the most frequent clinical sequelae.Two patients （3 eyes,13.6%） had severe vison loss with corneal neovascularization and conjunctivization.One patient had asymmetric binocular disease.Corneal epithelial cells were observed at an active state in 10 patients （19eyes,86.4%） and corneal stromal cells at an active state in all patients （22 eyes,100%）.Twenty eyes （10 patients,91%） were noted with abnormal nerve layout and 10 eyes （5 patients,45.5%） with dendritic cell infiltration around pathological nerve damages.Numerous inflammory cells were observed in 6 eyes （3 patients,27.3%）.Conclusions The corneas of patients with chronic ocular sequelae associated with SJS or TEN present a number of abnormalities.In vivo confocal microscopy is a potetial useful tool for therapeutic indications and for follow-up of the debilitating chronic ocular problems linked to SJS and TEN.

关 键 词：STEVENS-JOHNSON综合征 表皮坏死松解症 中毒性 角膜疾病 干眼综合征 角膜炎 显微镜检查 共焦 

分 类 号：R595.3[医药卫生—内科学] R771.3[医药卫生—临床医学]