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目的探讨II型糖尿病患者的角膜在共焦显微镜下各层细胞形态学特征。方法应用Confoscan3.0共焦显微镜对120例(146只眼)II型糖尿病患者和36例(36只眼)同年龄对照组的中央角膜进行检查,依据双目间接眼底镜和眼底荧光血管造影检查的结果,将糖尿病患者分为三组:糖尿病无眼底改变(NDRP)组、非增生性糖尿病视网膜病变(NPDR)组、增生性糖尿病视网膜病变(PDR)组,记录角膜各层细胞的图像,并对其进行分析。结果共焦显微镜下可以观察到糖尿病引起的角膜神经营养性上皮病变;和对照组比较,2型糖尿病患者角膜上皮下神经丛神经分支密度减少,神经纤维的密度在PDR组明显减少,NPDR组、NDRP组的减少不明显。角膜基质中形态异常的神经纤维在糖尿病组中出现的机率也明显高于对照组;角膜前基质细胞密度在PDR组有明显减少,后基质细胞在NPDR组和PDR组均明显降低,NDRP组减少不明显;糖尿病组的后弹力膜层病变表现为特征性的皱折形成;糖尿病各组角膜内皮细胞密度较对照组无显著性差异,但糖尿病各组的细胞面积变异系数高于对照组,六角形细胞所占的百分比在糖尿病各组均较对照组减少,且随着糖尿病视网膜病变的进展,六角形细胞的百分比亦逐渐减少,差异有统计学意义。结论共焦显微镜检查是一种有效、无创的角膜检查方法,糖尿病对角膜每一层结构均有重要影响,角膜上皮层、角膜神经、基质细胞密度、内皮细胞密度和形态均存在改变。
Objective To investigate the morphological features of corneal layers in patients with type 2 diabetes under confocal microscope. Methods The central cornea of 120 patients (146 eyes) with type II diabetes mellitus and 36 patients (36 eyes) with the same age control group were examined by confocal microscope. According to the binocular indirect ophthalmoscopy and fundus fluorescein angiography The diabetic patients were divided into three groups: diabetic retinopathy (NDRP) group, non-proliferative diabetic retinopathy (NPDR) group, proliferative diabetic retinopathy (PDR) group, the images of corneal layers were recorded, and Analyze it. Results Compared with the control group, the corneal neurotrophic epithelial lesions caused by diabetes were observed under confocal microscope. Compared with the control group, the densities of subcortical plexus nerve branches in the type 2 diabetic patients decreased and the density of nerve fibers decreased significantly in the PDR group. Compared with the control group, The decrease of NDRP group was not obvious. The incidence of morphological abnormalities in the corneal stroma was also significantly higher in the diabetic group than in the control group; the density of pre-keratinocytes was significantly decreased in the PDR group, the post-stromal cells were significantly reduced in the NPDR group and the PDR group, and decreased in the NDRP group But the density of corneal endothelial cells in diabetic group showed no significant difference compared with the control group, but the coefficient of variation of cell area in each group was higher than that in the control group The percentage of angiocytes in all groups of diabetes decreased compared with the control group, and with the progress of diabetic retinopathy, the percentage of hexagonal cells also gradually decreased, the difference was statistically significant. Conclusions Confocal microscopy is an effective and noninvasive method of corneal examination. Diabetes mellitus has an important effect on the structure of each cornea. There are changes in the corneal epithelium, corneal nerve, stromal cell density, endothelial cell density and morphology.