CAJ | 학술논문

背景丝状角膜炎患者临床症状较重,易复发,病因复杂,治疗十分棘手.目前,其发病机制仍不明确,对丝状物构成方面的研究较少,结果不一. 目的应用影像学检查结合组织病理学方法检测丝状角膜炎患者丝状物的组成结构,分析角膜丝状物的形成机制.方法收集山东省眼科医院2008年1月至2011年1月收治的丝状角膜炎患者82例88眼,详细记录患者的病史等临床资料,并根据病因进行分类.采用高清光学相干断层扫描(HD-OCT)检查角膜丝状物附着处的角膜结构,激光扫描共焦显微镜(LSCM)检查角膜丝状物的组成结构,然后取丝状物铺片行Giemsa染色及Masson三色染色,分析丝状物的成分.结果穿透角膜移植术后发生丝状角膜炎者40例；白内障手术、准分子激光角膜切削术(PRK)等术后发生者18例；眼部功能失调,如干眼、神经营养不良性角膜病者14例；急性结膜炎患者10例.HD-OCT显示丝状物病变可累及前弹力层.LSCM检查显示,丝状物由上皮细胞、炎性细胞、黏液、高反光螺旋状条索形核心构成,核心中含有上皮细胞、炎性细胞及纤维状组织.Giemsa染色结果显示,角膜丝状物含有角膜上皮细胞、炎性细胞和黏液,丝状物中央有螺旋状深蓝染的条状核心,核心中含有炎性细胞、上皮细胞、纤维状细胞.Masson三色染色表明,条状核心呈红色纤维组织,周围黏液为蓝色.结论角膜炎丝状物的主要成分有条状核心、炎性细胞、上皮细胞和黏液,病变较深,可达前弹力层.
배경 사상각막염환자림상증상교중,역복발,병인복잡,치료십분극수.목전,기발병궤제잉불명학,대사상물구성방면적연구교소,결과불일. 목적 응용영상학검사결합조직병이학방법검측사상각막염환자사상물적조성결구,분석각막사상물적형성궤제.방법 수집산동성안과의원2008년1월지2011년1월수치적사상각막염환자82례88안,상세기록환자적병사등림상자료,병근거병인진행분류.채용고청광학상간단층소묘(HD-OCT)검사각막사상물부착처적각막결구,격광소묘공초현미경(LSCM)검사각막사상물적조성결구,연후취사상물포편행Giemsa염색급Masson삼색염색,분석사상물적성분.결과 천투각막이식술후발생사상각막염자40례；백내장수술、준분자격광각막절삭술(PRK)등술후발생자18례；안부공능실조,여간안、신경영양불량성각막병자14례；급성결막염환자10례.HD-OCT현시사상물병변가루급전탄력층.LSCM검사현시,사상물유상피세포、염성세포、점액、고반광라선상조색형핵심구성,핵심중함유상피세포、염성세포급섬유상조직.Giemsa염색결과현시,각막사상물함유각막상피세포、염성세포화점액,사상물중앙유라선상심람염적조상핵심,핵심중함유염성세포、상피세포、섬유상세포.Masson삼색염색표명,조상핵심정홍색섬유조직,주위점액위람색.결론 각막염사상물적주요성분유조상핵심、염성세포、상피세포화점액,병변교심,가체전탄력층.
Background Eyes with filamentary keratitis present with serious clinical symptoms.This disease is easy to relapse and the treatment is tricky.At present,its pathogenesis is still unclear,and few works were done on filamentous composition.Objective This study was to analyze the composition of corneal filament by imageological and histopathological method,and discuss the formation mechanism of filamentary keratitis.Methods Eighty-eight eyes of 82 cases who suffered from filamentary keratitis were collected in Shandong Eye Hospital between January 2008 and January 2011.The etiologies of the patients were classified and the clinical data were recorded.Firstly,the corneal filiform strip was detected by laser scanning confocal microscopy (LSCM),and the corneal structure was examined by high-definition optical coherence tomography (HD-OCT).Then the composition of filamentary strip was analyzed by Giemsa and Masson trichrome staining of stretched preparation of filiform strip.Results Etiological study showed that filamentary keratitis occurred after penetrating keratoplasty in 40 eyes,after cataract surgery and photorefractive keratectomy (PRK) in 18 eyes,dry eye and neural dystrophic corneal disease in 14 eyes,acute conjunctivitis in 10 eyes.HD-OCT revealed that filament lesion developed to Bowman layer.Filament was composed of epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement under the LSCM,and epithelial cells,inflammatory cells and fibrous tissue were seen in the strip core.Giemsa staining exhibited that filament contained corneal epithelial cells,inflammatory cells,mucus and dark blued strip core with helical arrangement.Masson trichrome discovered that the strip core was red fibrous tissue surrounding by blue mucus.Conclusions Epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement are the main elements of filament in filamentary keratitis.The lesion can reach Bowman layer.The results contribute to reveal the formation mechanism of corneal filament and assist treatment.