CAJ | 학술논문

目的应用激光共聚焦显微镜(LSCM)联合高清光学相干断层扫描(HD-OCT)检测丝状角膜炎丝状物的组成结构,指导丝状角膜炎的个体化治疗.方法前瞻性病例研究.2009年1月至2011年1月山东省眼科医院确诊的丝状角膜炎患者70例(76眼).根据病因进行分类,详细记录患者治疗过程.治疗前应用LSCM检测角膜丝状物组成,进行炎症细胞计数,HD-OCT检查丝状物累及角膜的深度.针对病因治疗前提下,根据LSCM检查结果,个体化应用抗炎药物、抑制增殖药物、黏液溶解剂;根据HD-OCT确定去除角膜病灶的深度.结果通过LSCM观察到角膜丝状物由不同直径高反光的核心、上皮细胞、炎症细胞组成.炎症细胞的密度在不同的患者之间存在个体差异,平均炎症细胞计数＜5/视野12眼,10/视野＞炎症细胞计数＞5/视野26眼；炎症细胞计数≥10/视野38眼.HD-OCT可以观察到角膜丝状物病变深者达到前弹力层.个体化治疗后,患者的治愈率达到了100％,随诊1年未见复发,治愈后HD-OCT检查发现病变处未遗留瘢痕.结论 LSCM结合HD-OCT检测角膜丝状物结构,可以个体化地指导丝状角膜炎的治疗,并取得了良好的治疗效果.
목적 응용격광공취초현미경(LSCM)연합고청광학상간단층소묘(HD-OCT)검측사상각막염사상물적조성결구,지도사상각막염적개체화치료.방법 전첨성병례연구.2009년1월지2011년1월산동성안과의원학진적사상각막염환자70례(76안).근거병인진행분류,상세기록환자치료과정.치료전응용LSCM검측각막사상물조성,진행염증세포계수,HD-OCT검사사상물루급각막적심도.침대병인치료전제하,근거LSCM검사결과,개체화응용항염약물、억제증식약물、점액용해제;근거HD-OCT학정거제각막병조적심도.결과 통과LSCM관찰도각막사상물유불동직경고반광적핵심、상피세포、염증세포조성.염증세포적밀도재불동적환자지간존재개체차이,평균염증세포계수＜5/시야12안,10/시야＞염증세포계수＞5/시야26안；염증세포계수≥10/시야38안.HD-OCT가이관찰도각막사상물병변심자체도전탄력층.개체화치료후,환자적치유솔체도료100％,수진1년미견복발,치유후HD-OCT검사발현병변처미유류반흔.결론 LSCM결합HD-OCT검측각막사상물결구,가이개체화지지도사상각막염적치료,병취득료량호적치료효과.
Objective To evaluate the treatment for filamentary keratitis guided by laser scanning confocal microscopy (LSCM) and high-definition optical coherence tomography (HD-OCT).Methods This was a prospective case series study.The study included 76 eyes from 70 patients who presented with filamentary keratitis at the Shandong Eye Institute and Hospital between January 2009 and January 2011.LSCM was performed on the diseased cornea and inflammatory cells were counted.HD-OCT was performed the depth of filaments.On the basis of etiological status,individual treatments were carried out according to the filament structure to ensure that the appropriate combination and dose of anti-inflammatories,proliferation inhibitors,mucolytic agents or combinations for removing the filaments were used.Results The approximate structure of the filaments was observed in vivo with LSCM and HD-OCT.The depth and width of the filaments' core was shown simultaneously.The density of inflammatory cells could be detected clearly and the structure of the filament varied in different patients.Twelve eyes had inflammatory cell counts ＜5/ visual field,26 eyes had ≥5/ to ＞10/ visual field＞inflammatory cell counts,38 eyes had inflammatory cell counts ≥10/ visual field.At 1 month after individual treatment based on etiological status,a 100％ cure rate was achieved.The cornea recovered without scarring as shown by HD-OCT.No recurrence was observed at the 12-month follow-up.Conclusion LSCM combined with HD-OCT is an effective and rapid method to guide the treatment of filamentary keratitis.It provides valuable and objective information that is required in selecting individual therapeutic regimens to treat filamentary keratitis.