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目的 了解圆锥角膜患者对侧无明显临床改变眼的共焦显微镜的影像特点 ,探索共焦显微镜在早期圆锥角膜的临床检查中的意义和诊断价值。方法 前瞻性的应用共焦显微镜研究评价37例圆锥角膜患者对侧眼无明显临床改变者、 6 2例中高度近视和 4 3例中高度近视角膜接触镜佩戴者作对照 ,比较各组之间的图像、角膜基质、内皮细胞的密度等。结果 圆锥角膜对侧眼无明显临床改变者组和中高度近视组、中高度近视接触镜组比较 ,其年龄、近视度数、散光度数均无统计学差异(均P >0 .0 5)。共焦显微镜检查中发现圆锥角膜患者对侧眼无明显临床改变者组中有 8例出现前或后基质暗纹 ,对照组角膜没有发现类似的改变。角膜内皮细胞密度和角膜前、中、后基质细胞密度在早期圆锥角膜与对照组之间无明显统计学差异 (均P >0 .0 5)。各组间上皮下神经的形态结构没有明显差别。结论 共焦显微镜可活体检查圆锥角膜组织结构和细胞的改变 ,是一种新的临床检测手段 ,它为早期圆锥角膜的诊断提供了一种新的思路 ,具有一定的诊断价值。
Objective To understand the characteristics of confocal microscopy in patients with keratoconus who had no clinically significant changes in the contralateral eye and to explore the significance and diagnostic value of confocal microscopy in clinical examination of early keratoconus. Methods Forty-seven patients with keratoconus who had no clinically significant changes in the contralateral eye were evaluated by confocal microscopy prospectively. Sixty-two patients with moderate-to-high myopia and 43 with high-myopia myopic contact lens wears were used as controls. The corneal stroma, the density of endothelial cells, and so on. Results There was no significant difference in the age, myopia and astigmatism between the contralateral cornea and the high and middle myopia group (P> 0.05). In confocal microscopy examination, there was no obvious clinical change in the contralateral eye in patients with keratoconus. There were 8 cases of frontal or posterior stromal obscuration in the control group, and no similar changes were found in the control cornea. Corneal endothelial cell density and anterior corneal, mid and post-corneal stromal cell density were not significantly different between the early keratoconus and the control group (all P> 0.05). There was no significant difference in the morphological structure of the subepithelial nerves between the groups. Conclusions Confocal microscopy can detect the changes of keratoconus tissue and cells in vivo. It is a new clinical detection method. It provides a new idea for the diagnosis of early keratoconus and has a certain diagnostic value.