活体共聚焦显微镜观察视网膜激光光凝术对角膜上皮下神经的影响  

Effect of retinal photocoagulation on corneal sub-basal nerve observed by in vivo confocal microscopy

作　　者：刘瑞[1,2] 李冰 徐鼎 盛敏杰[2] LIU Rui;LI Bing;XU Ding;SHENG Minjie(Department of Ophthalmology,Tenth People＇s Hospital of Tongji University,Shanghai 200072;Department of Ophthalmology,Yangpu Hospital of Tongji University,Shanghai 200090,China)

机构地区：[1]同济大学附属第十人民医院眼科,上海200072 [2]同济大学附属杨浦医院眼科,上海200090

出　　处：《眼科学报》2018年第2期101-107,共7页Eye Science

基　　金：国家自然科学基金(81400373)~~

摘　　要：目的:应用活体共聚焦显微镜(in vivo confocal microscopy,IVCM)观察视网膜激光光凝术对角膜上皮下神经的影响。方法:收集行视网膜激光光凝术的患者36例46眼,分为糖尿病性视网膜病变(diabetic retinopathy,DR)组(14例22眼)与非DR组(22例24眼),在治疗前及治疗后1周、1个月应用IVCM采集两组角膜基底层下神经纤维图像,使用Image J和Neuron J软件计算其长度及密度。结果:DR组术前角膜神经纤维主干密度(corneal nerve fiber density,CNFD)、角膜神经纤维分支密度(corneal nerve branch density,CNBD)和角膜神经纤维长度(corneal nerve fiber length,CN F L)均低于非DR组,角膜神经弯曲度(corneal nerve fiber tortuosity,CNFT)高于非DR组。两组间角膜神经总分支节点密度(corneal total branch node,CTBN)无显著差异。DR组光凝术后CNFD,CNFL测量值持续降低,术前、术后1周、术后1个月3个观察时段两两之间的差异有统计学意义;光凝术后1个月CNFT与术前的差异有统计学意义。非DR组光凝术后CNFD,CNFL持续降低,术前、术后1周、术后1个月3个观察时段两两之间的差异有统计学意义;CNBD持续升高,术后1周、术后1个月测量值与术前的差异有统计学意义;CNFT持续升高,术后1周、术后1个月测量值与术前的差异均有统计学意义。结论:IVCM结合附属软件可量化评估角膜上皮下神经,糖尿病状态和视网膜激光光凝均可对角膜上皮下神经造成损伤。Objective： To evaluate the effect of retinal photocoagulation on corneal sub-basal nerve using in vivo confocal microscopy（IVCM）. Methods： In this study, 46 eyes of 36 cases were enrolled. All patients were divided into two groups, 22 eyes in the diabetic retinopathy（DR） group and 24 eyes in the non-diabetic retinopathy（NDR） group. IVCM images were obtained to observe sub-basal nerve plexus before retinal photocoagulation and 1 week, 1 mouth after the treatment. Image J and Neuron J software were used for analysis. Results： In the DR group, before retinal photocoagulation, the corneal nerve fiber density（CNFD）, corneal nerve branch density（CNBD） and corneal nerve fiber length（CNFL） were lower than those in the NDR group while the corneal nerve fiber tortuosity（CNFT） was higher than that in the NDR group. There were no significant differences in corneal total branch node（CTBN） between two groups. The CNFD, CNFL were decreased constantly in the DR group. No statistical significance was observed in either CNBD or CTBN at any time point. After the treatment, the CNFT was enhanced; however, significant differences were noted between 1 week and 1 month. In the NDR group, CNFD, CNFL were declined continually to 1 month, whereas CNBD was increased. CTBN was slightly elevated at each time point without statistical significance. After treatment, CNFT was significantly increased, whereas no statistical significance was observed between 1 week and 1 month. Conclusion： IVCM combined with assistant software could be used to quantify corneal sub-basal nerve fiber. Retinal photocoagulation as well as diabetes mellitus can injure corneal sub-basal nerve fiber.

关 键 词：共聚焦显微镜 角膜神经 激光光凝术 糖尿病 

分 类 号：R587.2[医药卫生—内分泌] R779.63[医药卫生—内科学]