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目的探讨2型糖尿病患者共焦显微镜下的角膜神经分布及形态学特征。方法应用 Confoscan 3.0共焦显微镜观察59例(65只眼)2型糖尿病患者和26例(26只眼)同年龄对照组白内障手术患者的中央角膜神经分布和形态学特征,依据双目间接检眼镜和荧光素眼底血管造影检查结果,将糖尿病患者分为3组:糖尿病无眼底改变(NDR)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,记录并分析患者角膜上皮下神经丛和角膜基质神经图像。结果与对照组相比,2型糖尿病患者角膜上皮下神经丛神经分支密度、神经纤维长度均减少,差异有统计学意义(P<0.01),神经纤维的密度仅 PDR 组明显减少,NPDR 组、NDR 组减少不明显。角膜基质中形态异常的神经纤维在糖尿病患者中出现的几率也明显高于对照组,两组差异有统计学意义(P<0.01)。结论共焦显微镜是一种有效、无创的角膜神经检查方法,2型糖尿病患者角膜上皮下神经丛、角膜基质神经均显示形态学异常。(中华眼科杂志,2006,42:896-900)
Objective To investigate the corneal nerve distribution and morphological features of patients with type 2 diabetes under confocal microscope. Methods The central corneal nerve distribution and morphological characteristics of 59 patients (65 eyes) with type 2 diabetes mellitus and 26 patients (26 eyes) with the same age group under cataract surgery were observed by Confocalan 3.0 confocal microscope. According to the binocular indirect ophthalmoscope And fluorescein angiography, the diabetic patients were divided into three groups: diabetic retinopathy (NDR) group, nonproliferative diabetic retinopathy (NPDR) group, proliferative diabetic retinopathy (PDR) group, recorded and analyzed Patients with corneal subcutaneous nerve plexus and corneal stromal nerve images. Results Compared with the control group, the branch density and the length of the nerve fibers in the corneal epithelium of type 2 diabetic patients decreased, with statistical significance (P <0.01). The density of the nerve fibers decreased only in the PDR group. In the NPDR group, NDR group decreased less obvious. The incidence of morphologically abnormal nerve fibers in the corneal stroma was also significantly higher in diabetic patients, with significant difference between the two groups (P <0.01). Conclusions Confocal microscopy is an effective and noninvasive method of corneal nerve examination. Morphological abnormalities of corneal epithelial cells and corneal stromal nerve are found in patients with type 2 diabetes mellitus. (Chinese Journal of Ophthalmology, 2006,42: 896-900)