摘要
目的 观察临床上不同阶段圆锥角膜的共焦显微镜图像，推测圆锥角膜的病理发展过程，并进行圆锥角膜的共焦显微镜分级。方法 采用共焦显微镜（Confoscan 2．0），观察24例24眼不同发展阶段（lawless分期）圆锥角膜患者的角膜共焦显微镜图像，进行分析并提出焦显微镜下的临床分分期。结果 共焦显微镜下圆锥角膜首先出现了排列规则的裂隙状暗纹，随着病情的不断进展，病变逐渐由角膜后弹力层向前发展，逐渐累及角膜的后基质和前基质，同时角膜基质细胞核拉长、排列出现紊乱，前后基质细胞失去了原有特征。急性圆锥角膜的患者角膜基质细胞出现水肿，角膜瘢痕在共焦显微镜下呈强反光的无细胞样结构。讨论 共焦显微镜下圆锥角膜的病理发展过程，是从角膜后弹力层开始，由后向前发展，逐渐累及角膜的后基质、前期基质，最后角膜破裂引起急性圆锥角膜，角膜出现水肿，愈合后遗留瘢痕。据此提出圆锥角膜共焦显微镜分期将为四个阶段：第一阶段、角膜裂隙样暗纹累及角膜后弹力层；第二阶段、角膜裂隙样暗纹累及角膜后后基质；第三阶段、角膜裂隙样暗纹累及角膜前基质；第四阶段、出现角膜基质水肿或者瘢痕。
Objective To observe the histological and morphological changes of keratoconus by confocal microscope,presume the pathological progress of keratoconus,and classify the clinical keratoconus. Methods In vivo confocal microscope（Concoscan2.0,Nidek ）was performed on twenty four patients（twenty four eyes） of different periods of keratoconus .The corneas images were recorded and analysed by NEVIS soft system.All findings were compared with data from healthy corneas .Results There were a great deal of regu- larly cranny-like dark strias in the images of keratoconus by confocal microscope.The strias were involved to posterior stroma, anterior stroma from the Descemet membrane by and by.At the same time,the uncleus of keratocyte were elongated shape,the arrangement of keratocytes were disorder.At The acute keratoconus,the cornea was edema.The white stroma scar in slip-lamp microscope was high-light reflected fiber-like structure in confocal microscope.Conclusions As soon as the developing of keratoconus,the cranny-like dark strias were observed from the Descemet membrane to posterior stroma, anterior stroma,At last,the cornea was broken and resulted in the acute keratoconus .The cornea was edema in acute keratoconus and was scar when healing.The keratoconus was classified four stages by confocal microscope. The first stage,the cranny-like dark strias were involved the Descemet membrane.The second stage,involved posterior stroma stroma.The third stage,involved anterior stroma,The fourth stage,there were edema or scars.
出处
《中国实用眼科杂志》
CSCD
北大核心
2007年第8期861-865,共5页
Chinese Journal of Practical Ophthalmology
