中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2009年
4期
416-419
,共4页
胡蓉蓉%顾扬顺%李修义%汪晓宇
鬍蓉蓉%顧颺順%李脩義%汪曉宇
호용용%고양순%리수의%왕효우
虹膜角膜内皮综合征%共焦显微镜%角膜内皮
虹膜角膜內皮綜閤徵%共焦顯微鏡%角膜內皮
홍막각막내피종합정%공초현미경%각막내피
Iridocorneal endothelial syndrome%Confocal microscopy%Corneal endothelium
目的 探讨共焦显微镜检查在虹膜角膜内皮综合征临床诊断中的应用价值.方法 对8例(其中6例单眼患病,2例双眼患病)常规检查无法确诊的疑似虹膜角膜内皮综合征病例进行共焦显微镜检查.观察角膜内皮层病变结构.结果 活体共焦显微镜检查发现患眼角膜内皮细胞均偏大而且形状不规则,细胞核反光明显增高,可见散在双核、多核、偏位核及分叶核等改变,7例细胞边界模糊,部分病例有局灶内皮细胞缺失、胞内环形暗区、分裂状细胞等改变.此外,3例单眼患病病例的对侧眼在共焦显微镜下发现内皮细胞密度下降、大小不均等改变.最后确诊为原发性进行性虹膜萎缩型2例、Chandler综合征4例、Cogan-Reese综合征2例.结论 共焦显微镜可以在细胞水平上无创、高分辨率地观察到虹膜角膜内皮综合征患眼角膜内皮层特征性的显微结构改变,且不受角膜水肿的影响,大大提高了虹膜角膜内皮综合征诊断的准确性,并有助于早期诊断,具有很高的应用价值.
目的 探討共焦顯微鏡檢查在虹膜角膜內皮綜閤徵臨床診斷中的應用價值.方法 對8例(其中6例單眼患病,2例雙眼患病)常規檢查無法確診的疑似虹膜角膜內皮綜閤徵病例進行共焦顯微鏡檢查.觀察角膜內皮層病變結構.結果 活體共焦顯微鏡檢查髮現患眼角膜內皮細胞均偏大而且形狀不規則,細胞覈反光明顯增高,可見散在雙覈、多覈、偏位覈及分葉覈等改變,7例細胞邊界模糊,部分病例有跼竈內皮細胞缺失、胞內環形暗區、分裂狀細胞等改變.此外,3例單眼患病病例的對側眼在共焦顯微鏡下髮現內皮細胞密度下降、大小不均等改變.最後確診為原髮性進行性虹膜萎縮型2例、Chandler綜閤徵4例、Cogan-Reese綜閤徵2例.結論 共焦顯微鏡可以在細胞水平上無創、高分辨率地觀察到虹膜角膜內皮綜閤徵患眼角膜內皮層特徵性的顯微結構改變,且不受角膜水腫的影響,大大提高瞭虹膜角膜內皮綜閤徵診斷的準確性,併有助于早期診斷,具有很高的應用價值.
목적 탐토공초현미경검사재홍막각막내피종합정림상진단중적응용개치.방법 대8례(기중6례단안환병,2례쌍안환병)상규검사무법학진적의사홍막각막내피종합정병례진행공초현미경검사.관찰각막내피층병변결구.결과 활체공초현미경검사발현환안각막내피세포균편대이차형상불규칙,세포핵반광명현증고,가견산재쌍핵、다핵、편위핵급분협핵등개변,7례세포변계모호,부분병례유국조내피세포결실、포내배형암구、분렬상세포등개변.차외,3례단안환병병례적대측안재공초현미경하발현내피세포밀도하강、대소불균등개변.최후학진위원발성진행성홍막위축형2례、Chandler종합정4례、Cogan-Reese종합정2례.결론 공초현미경가이재세포수평상무창、고분변솔지관찰도홍막각막내피종합정환안각막내피층특정성적현미결구개변,차불수각막수종적영향,대대제고료홍막각막내피종합정진단적준학성,병유조우조기진단,구유흔고적응용개치.
Objective To discuss the diagnostic potential of confocal microscopy for iridocomeal endothelial(ICE)syndrome.Methods Eight patients(six patients unilaterally involved and two patients bilaterally involved)of suspected ICE syndrome,which can't be diagnosed with conventional examination,were collected.Tbe corneal endothelium of all eight patients were detailedly investigated by confocal microscopy.Results In-vivo confocal microscopy highlighted larger and irregularly shaped endothelial cells with marked hyperrefleetive nuclei in all eight patients and indistinct cellular borders in seven patients.Cells with two or more nuclei, nuclei with sublobes or adjacent to the cellular borders could be found.Several patients exhibited local loss of endothelial cells, ring-shaped dark area in the cells, cells appearing during the division phase, and so on. The contralateral eyes in 3 patients with unilateral ICE syndrome exhibited lower endothelial cell density and less homogenicity in cellular size.According to confocal microscopy,the eight patients were diagnosed as two cases of progressive essential iris atrophy, four cases ofChandler's syndrome and two cases ofCogan Reese syndrome.Conclusion Confocal microscopy,which allows the hurtless evaluation ofthe corneal endothelium at the cellular level,can be used as the definitive,early diagnostic method in ICE syndrome,despite the presence of corneal edema.The technique has great potential for diagnosing ICE syndrome, especially for the atypical cases.
