摘要目的 观察共焦显微镜下虹膜角膜内皮综合征(ICE)的角膜各层组织的形态学特点.方法 观察型系列病例研究.对2000年1月至2007年6月在复旦大学附属眼耳鼻喉科医院眼科就诊的23例(23只眼)ICE患者,行共焦显微镜(NIDEK,Confoscan 3.0)下双眼检查.使用NAVIS软件记录和分析角膜各层组织图像,并使用SPSS 13.0软件对患眼的角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例及有核细胞比例进行单因素方差分析.结果 ICE患眼的角膜内皮细胞呈"风筝样"或"上皮细胞样",细胞形态失去正常的六角形外观,细胞排列紊乱,胞内可见高反光的细胞核,部分细胞内可见双核或细胞分裂象.随病程时间延长,患眼角膜内皮细胞密度和六角形细胞比例逐渐下降.病程短于1年、1～3年、3～5年及超过5年患者的角膜内皮细胞密度分别为(1687.1±122.6)、(1210.6±168.7)、(947.3±145.2)及(856.8±73.4)个/mm2;六角形细胞比例分别为(51.5±6.3)%、(39.8±9.2)%、(32.7±8.1)%及(24.1±5.6)%.随病程时间延长,患眼角膜内皮细胞平均面积和有核内皮细胞比例逐渐升高.病程短于1年、1～3年、3～5年及超过5年患者的内皮细胞平均面积分别为(678.3±56.3)、(928.7±96.2)、(1188.5±72.6)及(1337.5±60.8)μm2;有核细胞比例分别为(12.6±1.4)%、(56.8±3.7)%、(78.7±5.6)%及(84.3±2.8)%(F=7.158,7.736,6.876,14.452;均P=0.000).患眼基质细胞形态无异常,但是随病程延长,基质神经纤维逐渐增粗并明显扭曲.患眼上皮细胞的形态无异常.对侧眼角膜的各层形态结构无明显异常.结论 共焦显微镜下ICE患眼的角膜内皮细胞表现有一定特点,共焦显微镜对于判断ICE的病程进展有诊断价值.

abstractsObjective To evaluate the morphological changes of cornea in iridocomeal endothelial syndrome(ICE) under the examination of in vivo confocal microscopy. Methods The experimental design was retrospective observation case series. Twenty-three eyes of 23 consecutive patients, each diagnosed as ICE,had their both eyes examined with the in vivo confocal microscopy (N1DEK, confoscan 3.0). The images were recorded and analyzed by software NAVIS. Measurements were performed on endothelium density, average endothelial area, the percentage of hexagonal cells and the percentage of endothelium with nuclei, and the ANOVA was done to assess the differences. Results In vivo confocal microscopy highlighted two main patterns of endothelial changes: "kite-llke" and " eplthelial-like" abnormal endothelium, characterised by marked hyperreflective nuclei and loss of regularity in cellular size and shape. With the progression of disease, the endothelium density and the percentage of hexagonal endothelial ceils decreased, which were (1687.1±122.6), (1210.6±168.7), (947.3±145.2), (856.8±73.4) cells/mm2 and (51.5±6.3) %, (39.8±9.2) %, (32.7±8.1) %, (24.1±5.6) % respectively in detail In contrast, the average endothelial area the percentage of endothelium with nuclei increased, which were (678.3±56.3), (928.7±96.2) ,(1188.5±72.6) ,(1337.5±60. 8)μm2 and(12.6±1.4)% ,(56.8±3.7)% ,(78.7± 5.6) %, (84.3±2.8) %. The differences all had statistical significance (F = 7.158,7.736,6.876,14.452 respectively ,P = 0.000). The morphology of keratocyte and endothelium were normal, compared with the eontralateral healthy eyes. However, the stremal nerves became thicker and more tortuous with the disease advancement. Conclusions The application of confocal microscopy indicates that the ICE is charactcrised by epithelial-like endothelial cells with hyperreflecfive nuclei. The technique has great potential in diagnosing ICE,especially in evaluating the disease progression.