CAJ | 학술논문

目的探讨后部多形性角膜营养不良的临床特点及其在共焦显微镜下的改变.方法回顾性系列病例研究.对2007年3月至2009年8月河南省眼科研究所视光门诊就诊的10例后部多形性角膜营养不良患者行详细的裂隙灯显微镜检查及眼前节照相,并行共焦显微镜、角膜内皮镜及OrbscanⅡ等检查,分析其特点.采用Mann-Whitney U检验进行统计学分析.结果 10例患者年龄范围8～35岁,其中囊泡状后部多形性角膜营养不良4例(7只眼),带状后部多形性角膜营养不良5例(5只眼),弥漫性后部多形性角膜营养不良1例(2只眼),共计10例(14只眼).1例囊泡状病变者双眼合并高眼压症状,2例带状病变者(2只眼)伴有角膜地形图异常,表现为角膜后表面前突;1例弥漫性病变者双眼有虹膜周边前粘连,角膜基质水肿.角膜内皮镜检查显示病变角膜内皮细胞增大,平均大小为584μm2,而无病变眼为316 μm2,差异有统计学意义(U=0.000,P=0.002);内皮细胞数量减少,病变眼平均内皮细胞密度为1746个/mm2,无病变眼为3201个/mm2,差异有统计学意义(U=0.000,P=0.002).共焦显微镜检查可见角膜内皮细胞呈多形性改变;部分出现细胞核,部分皱缩呈橘皮样或指纹样外观,甚至内皮细胞缺失;囊泡状病变表现为圆形或椭圆形弹坑样或火山口样病灶;带状病变的病灶为宽带状,边缘呈堤状外观,病变区内皮细胞消失,可有纤维样组织增生,幅状粘连;弥漫性病变表现为内皮细胞大面积缺失,表面粗糙,呈沟壑状.结论后部多形性角膜营养不良经裂隙灯显微镜检查可明确诊断,共焦显微镜检查可辅助确诊,部分患者早期可有角膜地形图异常或伴有高眼压症状.
목적 탐토후부다형성각막영양불량적림상특점급기재공초현미경하적개변.방법 회고성계렬병례연구.대2007년3월지2009년8월하남성안과연구소시광문진취진적10례후부다형성각막영양불량환자행상세적렬극등현미경검사급안전절조상,병행공초현미경、각막내피경급OrbscanⅡ등검사,분석기특점.채용Mann-Whitney U검험진행통계학분석.결과 10례환자년령범위8～35세,기중낭포상후부다형성각막영양불량4례(7지안),대상후부다형성각막영양불량5례(5지안),미만성후부다형성각막영양불량1례(2지안),공계10례(14지안).1례낭포상병변자쌍안합병고안압증상,2례대상병변자(2지안)반유각막지형도이상,표현위각막후표면전돌;1례미만성병변자쌍안유홍막주변전점련,각막기질수종.각막내피경검사현시병변각막내피세포증대,평균대소위584μm2,이무병변안위316 μm2,차이유통계학의의(U=0.000,P=0.002);내피세포수량감소,병변안평균내피세포밀도위1746개/mm2,무병변안위3201개/mm2,차이유통계학의의(U=0.000,P=0.002).공초현미경검사가견각막내피세포정다형성개변;부분출현세포핵,부분추축정귤피양혹지문양외관,심지내피세포결실;낭포상병변표현위원형혹타원형탄갱양혹화산구양병조;대상병변적병조위관대상,변연정제상외관,병변구내피세포소실,가유섬유양조직증생,폭상점련;미만성병변표현위내피세포대면적결실,표면조조,정구학상.결론 후부다형성각막영양불량경렬극등현미경검사가명학진단,공초현미경검사가보조학진,부분환자조기가유각막지형도이상혹반유고안압증상.
Objective To resarch the clinical features and in vivo confocal microscopic findings of posterior polymorphous corneal dystrophy (PPCD). Methods It was a retrospective consecutive case study.Ten patients with PPCD, attended at Optometry Department of Henan Eye Institute from March 2007 to August 2009, were analyzed. All the subjects were examined by slit-lamp, Orbscan Ⅱ , specular microscopy,HRT3/RCM confocal microscopy. Mann-Whitney U test was used to analysis the data. Results The age of the patients ranged from 8 to 35 years. Seven eyes of the 4 patients have the vesicular lesions, five eves of the 5 patients were band lesions and 1 patient had bilateral diffused opacities, this patient also had iridocorneal adhesions with associated papillary ectropion but without glaucoma. In total, 14 eyes of the 10 patients had PPCD. Two eyes had abnormal Orbscan Ⅱ topography, it showed both anterior and posterior surface protrusion. Specular microscopy exam indicated large cells in size and reduced endothelium density.The mean size of the affected eye was 584 μm2 ,the normal eye was 316 μm2. The difference was statistically significant( U =0.000,P =0.002). The density of the endothelium was 1746 cells/mm2 in affected eye and 3201 cells/mm2 in normal eye. The difference was also statistically significant( U =0.000,P =0.002). In vivo confocal microscopy showed endothelial polymorphism. Occasional bright endothelial nuclei were seen. A variety of curvilinear and vesicular abnormalities were imaged including orange or finger like lesion, round or oval dark area with hyper reflectivity border. Some large lesions may lose endothelium with rough surface have a dike appearance. Conclusions Careful exam by slit-lamp may help to diagnose PPCD and further specular microscopy and (or) in vivo confocal microscopy exam will confirm it. Some cases may have abnormal topography, or associated with high intraocular pressure.