丝状角膜炎角膜丝状物构成分析

摘要

背景 丝状角膜炎患者临床症状较重,易复发,病因复杂,治疗十分棘手.目前,其发病机制仍不明确,对丝状物构成方面的研究较少,结果不一. 目的 应用影像学检查结合组织病理学方法检测丝状角膜炎患者丝状物的组成结构,分析角膜丝状物的形成机制.方法 收集山东省眼科医院2008年1月至2011年1月收治的丝状角膜炎患者82例88眼,详细记录患者的病史等临床资料,并根据病因进行分类.采用高清光学相干断层扫描(HD-OCT)检查角膜丝状物附着处的角膜结构,激光扫描共焦显微镜(LSCM)检查角膜丝状物的组成结构,然后取丝状物铺片行Giemsa染色及Masson三色染色,分析丝状物的成分.结果 穿透角膜移植术后发生丝状角膜炎者40例；白内障手术、准分子激光角膜切削术(PRK)等术后发生者18例；眼部功能失调,如干眼、神经营养不良性角膜病者14例；急性结膜炎患者10例.HD-OCT显示丝状物病变可累及前弹力层.LSCM检查显示,丝状物由上皮细胞、炎性细胞、黏液、高反光螺旋状条索形核心构成,核心中含有上皮细胞、炎性细胞及纤维状组织.Giemsa染色结果显示,角膜丝状物含有角膜上皮细胞、炎性细胞和黏液,丝状物中央有螺旋状深蓝染的条状核心,核心中含有炎性细胞、上皮细胞、纤维状细胞.Masson三色染色表明,条状核心呈红色纤维组织,周围黏液为蓝色.结论 角膜炎丝状物的主要成分有条状核心、炎性细胞、上皮细胞和黏液,病变较深,可达前弹力层.%Background Eyes with filamentary keratitis present with serious clinical symptoms.This disease is easy to relapse and the treatment is tricky.At present,its pathogenesis is still unclear,and few works were done on filamentous composition.Objective This study was to analyze the composition of corneal filament by imageological and histopathological method,and discuss the formation mechanism of filamentary keratitis.Methods Eighty-eight eyes of 82 cases who suffered from filamentary keratitis were collected in Shandong Eye Hospital between January 2008 and January 2011.The etiologies of the patients were classified and the clinical data were recorded.Firstly,the corneal filiform strip was detected by laser scanning confocal microscopy (LSCM),and the corneal structure was examined by high-definition optical coherence tomography (HD-OCT).Then the composition of filamentary strip was analyzed by Giemsa and Masson trichrome staining of stretched preparation of filiform strip.Results Etiological study showed that filamentary keratitis occurred after penetrating keratoplasty in 40 eyes,after cataract surgery and photorefractive keratectomy (PRK) in 18 eyes,dry eye and neural dystrophic corneal disease in 14 eyes,acute conjunctivitis in 10 eyes.HD-OCT revealed that filament lesion developed to Bowman layer.Filament was composed of epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement under the LSCM,and epithelial cells,inflammatory cells and fibrous tissue were seen in the strip core.Giemsa staining exhibited that filament contained corneal epithelial cells,inflammatory cells,mucus and dark blued strip core with helical arrangement.Masson trichrome discovered that the strip core was red fibrous tissue surrounding by blue mucus.Conclusions Epithelial cells,inflammatory cells,mucus and the high reflective strip core with spiral arrangement are the main elements of filament in filamentary keratitis.The lesion can reach Bowman layer.The results contribute to reveal the formation mechanism of corneal filament and assist treatment.