原发性闭角型青光眼患者的角膜共聚焦显微镜表现  

Confocal microscopy characteristics of cornea in patients with primary angle-closure glaucoma

作　　者：王伟伟[1] 姚倩[1] 杨欣[1] 周歆 孙娜[1] 刘建荣[1] WANG Weiwei;YAO Qian;YANG Xin;ZHOU Xin;SUN Na;LIU Jianrong(Xi'an Fourth Hospital/Shaanxi Eye Hospital/Guangren Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安市第四医院/陕西省眼科医院/西安交通大学附属广仁医院,陕西西安710004

出　　处：《临床医学研究与实践》2020年第28期1-4,共4页Clinical Research and Practice

基　　金：国家自然科学基金青年科学基金项目(No.81500719);陕西省创新人才推进计划-青年科技新星项目(No.2018KJXX-091)。

摘　　要：目的探讨原发性闭角型青光眼(PACG)患者的角膜共聚焦显微镜表现。方法本研究为横断面研究,分析41例(82只眼)急性PACG(APACG组)、34例(68只眼)慢性PACG(CPACG组)和30例(60只眼)白内障(对照组)患者的一般资料、共聚焦显微镜检查结果及角膜内皮镜检查结果。结果共聚焦显微镜下可见APACG急性发作期角膜上皮下神经纤维丛密度降低,基质层呈激活状态,基质细胞肿胀,反光增强,交联成网状;内皮细胞大小不均,细胞表面有点状高反光物质沉积[角膜后沉着物(KP)],病情严重者细胞体积增大变形、融合;内皮细胞密度平均(1 654±999)个/mm^2,与临床前期的(2 601±529)个/mm^2比较,差异具有统计学意义(t=5.588,P<0.001)。CPACG表现为部分角膜上皮细胞活化,上皮下神经纤维丛密度降低,内皮细胞异型性增加,内皮细胞密度平均(2 440±442)个/mm^2,与对照组的(2 582±372)个/mm^2无显著差异(t=1.945,P=0.054)。结论高眼压情况下可出现角膜上皮下神经纤维丛密度降低,内皮细胞异型性增加。急性高眼压比慢性高眼压对角膜损伤更重,表现为基质细胞活化,内皮细胞密度降低,角膜后出现KP。急性高眼压导致角膜水肿时,共聚焦显微镜观察角膜内皮细胞的效果优于角膜内皮镜。Objective To investigate the confocal microscopy characteristics of cornea in patients with primary angleclosure glaucoma(PACG).Methods In this cross-sectional study,the general information,check results of confocal microscopy and corneal endothelioscopy of 41 cases(82 eyes)with acute PACG(APACG group),34 cases(68 eyes)with chronic PACG(CPACG group)and 30 cases(60 eyes)with cataract patients(control group)were analyzed.Results Under confocal microscope,the density of the corneal subepithelial nerve fiber plexus decreased,stromal layer was activated,stromal cells swelled,reflection enhanced,and cross-linked into a network;the size of endothelial cells was uneven,with the deposition of punctate high reflective substances[keratic precipitate(KP)]on the surface of the cells,the cell volume increased,deformed and fused in severe cases;the average density of endothelial cells was(1654±999)cells/mm^2,which was significantly difference than(2601±529)cells/mm2 in preclinical stage(t=5.588,P<0.001).CPACG showed that some corneal epithelial cells were activated,the density of subepithelial nerve fiber plexus decreased and the atypia of endothelial cells increased,the average density of endothelial cells was(2440±442)cells/mm2,which was no significantly difference than(2582±372)cells/mm2 of the control group(t=1.945,P=0.054).Conclusion High intraocular pressure can reduce the density of corneal subepithelial nerve fiber plexus and increase endothelial cell atypia.Acute ocular hypertension causes more damage to the cornea than chronic ocular hypertension,which is manifested by activation of stromal cells,decreased endothelial cell density,and KP appears behind the cornea.When acute high intraocular pressure leads to corneal edema,confocal microscopy has better effect than corneal endothelium to observe corneal endothelial cells.

关 键 词：原发性闭角型青光眼 角膜 眼压 共聚焦显微镜 上皮下神经纤维丛 

分 类 号：R775[医药卫生—眼科]