泪液缺乏性干眼治疗转归的定量检测

Quantitative detection of aqueous tear deficiency dry eye treatment outcome

摘要:

目的：应用角膜共焦显微镜、结膜印迹细胞学在泪液缺乏性干眼治疗前后定量测定病变角膜上皮细胞、结膜细胞，以期进一步准确评价干眼的治疗效果及预后。 方法：选择临床确诊为泪液缺乏性干眼症患者21例41眼，根据患者病史、症状、角结膜体征及相关检查确诊为泪液缺乏性干眼。应用聚乙二醇滴眼液及卡波姆凝胶联合治疗所有干眼患者，治疗前后依据结膜印迹细胞检查对干眼患者结膜细胞的鳞状化生及杯状细胞数量的多少进行分级，并对治疗前后印迹细胞分级进行统计学比较。应用海德堡激光共聚焦显微镜观察干眼治疗前后角膜上皮下神经纤维的形态学改变，定量评价同级结膜细胞干燥程度下治疗前后角膜上皮细胞密度的变化。 结果：印迹细胞检查:治疗前≤Ⅱ级6眼，Ⅲ级25眼，≥Ⅳ级10眼；治疗6mo后≤Ⅱ级19眼(46.3%)，Ⅲ级17眼(41.5%)，≥Ⅳ级5眼（12.2%）。治疗前后不同级别印迹细胞患者比例显著改变(P＜0.05）。共焦显微镜下细胞形态学改变：治疗前明显的角膜上皮细胞坏死脱落区，细胞密度下降，角膜上皮下神经纤维出现分支杂乱、异常走行，未见上皮下神经纤维5眼。治疗6mo后区域性细胞密度增加，所有患者均可见上皮下神经纤维，少数病例仍可见分支杂乱、异常走行。共焦显微镜显示在同级结膜印迹细胞程度下，角膜上皮细胞密度治疗前后进行比较，统计学上具有显著性差异（P<0.05）。治疗后细胞密度明显增加。 结论：应用角膜激光共焦显微镜和结膜印迹细胞定量观察泪液缺乏性干眼的治疗转归，从而确定以上两种方法在干眼治疗评价中具有重要价值。

Abstract:

AIM:To quantitatively detect the diseased corneal epithelial cells, conjunctival cells before and after aqueous tear deficiency dry eye treatment by using corneal confocal microscope and conjunctival impression cytology, so as to further accurately evaluate the dry eye treatment outcome and prognosis. METHODS:There were 21 cases (41 eyes) which were clinically diagnosed as aqueous tear deficiency dry eye based on their history, symptoms, corneal and conjunctival signs and relevant examinations. All patients with dry eye were treated by polyethylene glycol eye drops combined with Carbopol gel. Based on conjunctival impression cytoscopy, squamous metaplasia and goblet cells number of conjunctival cells in dry eye patients were graded and the impression cells classification before and after treatment was statistically compared. Morphological change of nerve fibers under corneal epithelial before and after dry eye treatment was observed by using Heidelberg laser confocal microscopy. The changes of corneal epithelium cell density before and after treatment under peer conjunctival cells dryness were quantitatively evaluated. RESULTS:Impression cytoscopy: before treatment ≤ grade Ⅱ in 6 eyes, grade Ⅲ in 25 eyes, ≥grade Ⅳ in 10 eyes; 6 months after treatment ≤ grade Ⅱ in 19 eyes(463%), grade Ⅲ in 17 eyes(41.5%), ≥grade Ⅳ in 5 eyes（12.2%）. The proportion of patients with different levels of impression cells before and after treatment was significantly changed. Morphological changes under confocal microscopy: cell density decreased in cell necrosis exfoliated area of corneal epithelial before treatment; corneal subcutaneous nerve fibers appeared branch unorganized, abnormal strike line, no subcutaneous nerve fibers in 5 eyes. Regional cell density increased 6 months after treatment. All patients can seen subcutaneous nerve fibers, a small number of cases still appeared branch unorganized, abnormal strike line. Confocal microscopy showed under the conjunctival impression cytology degree at the same level, the corneal epithelial cell density before and after treatment were compared, there was statistically significant difference (P<0.05). The cell density was significantly increased after treatment. CONCLUSION: The aqueous tear deficiency dry eye treatment outcomes were quantitatively observed by using corneal confocal microscopy and conjunctival impression cytology in order to determine the significant value of above two methods in dry eye treatment evaluation.