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目的研究颗粒状角膜营养不良角膜各层组织的共焦显微镜形态改变。方法应用Confoscan2.0共焦显微镜对13例(26眼)颗粒状角膜营养不良患者的角膜进行扫描检查,记录与分析各层角膜图像。结果所有患眼前基质细胞及16/26眼后基质细胞结构不清,排列紊乱,并可见短棒状多形性强反光;6/26眼前弹力层不规则并增厚,神经纤维密度明显下降;6/26眼角膜上皮基底细胞层可见不定型的强反光;2/26眼角膜上皮细胞边界不清,排列呈疏松的蜂窝状,并出现不透明的强反光;所有患者角膜内皮细胞形态基本正常。视力0.3以下的患眼角膜上皮细胞层、上皮基底细胞层、前弹力层、后基质层发生形态异常的比例高于0.3以上的患眼(P<0.05)。结论1.共焦显微镜可活体检查颗粒状角膜营养不良角膜组织各层结构,起到类似病理组织切片的作用。2.前基质层形态异常可能是颗粒状角膜营养不良最基本的共焦显微镜形态特征,病情越重,前基质层以外的其它层次发生形态异常的可能性越大,但内皮细胞层一般不受累。3.共焦显微镜检查对颗粒状角膜营养不良手术方式的选择具有一定的参考价值。
Objective To study the morphological changes of confocal microscopy in corneal layers of granular corneal dystrophy. Methods The cornea of 13 patients (26 eyes) with granular corneal dystrophy was scanned with Confoscan 2.0 confocal microscope, and the corneal images were recorded and analyzed. Results All stromal cells in the frontal and 16/26 posterior stromal cells were unclear in structure and disordered in arrangement, and showed short rod-like pleomorphic reflex. The elastic layer was irregular and thickened in 6/26 eyes, and the density of nerve fibers was significantly decreased. 6 / 26 corneal epithelial basal cell layer can be seen unshaped strong reflective; 2/26 corneal epithelial cell boundary is unclear, arranged in a loose honeycomb, and the emergence of opaque strong reflective; corneal endothelial cells in all patients with normal morphology. The percentage of morphologically abnormalities in the corneal epithelial cell layer, epithelial basal cell layer, anterior elastic layer, and posterior stromal layer in patients with visual acuity of 0.3 or less was higher than that in patients with a visual acuity of 0.3 or more (P <0.05). Confocal microscopy can check the corneal structure of granular corneal dystrophy tissue structure, play a role similar to the pathological tissue sections. 2. The abnormal morphology of the anterior stromal layer may be the most basic morphological features of granular corneal dystrophy, the more severe the disease, the more likely the morphological abnormalities occur at other levels other than the anterior stromal layer, but the endothelial cell layer is generally not involved . 3. Confocal microscopy of granular corneal dystrophy surgical options have some reference value.