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角膜胶原交联术后的体内共聚焦显微镜观察研究

Mazzotta C, Hafezi F

期刊名称:OCUL SURF 眼球表面

卷期:第13卷(2015年)4期

摘要

        我们对84名实施了常规上皮角膜胶原交联(CXL)和加速CXL(ACXL)患者的体内共聚焦显微镜(IVCM)结果进行回顾性研究。分析结果证实,尽管在进行CXL和ACXL术后头6个月内前角膜基质细胞的平均密度显著减少,但在12个月后细胞密度又回到了基线值。治疗后所观察到的分界线表示通过不同组织密度的光散射(反射率变化)的一种表达。常规CXL后前-中角膜基质的一过性角膜混浊表示CXL诱导的基质胶原压实和重塑的一种间接征象。IVCM结果显示渗透治疗会变化到一定程度,但是内皮不会受到损坏,并且与CXL生物力学作用相关。角膜缘结构的IVCM结果未呈现出病理变化的证据。在手术完全恢复角膜敏感性之后上皮下和基质神经在12个月后恢复,并且没有神经营养障碍性事件发生。IVCM可以对角膜层进行详细的高倍率体内微形态分析,能够对由常规和加速CXL诱发的早期和晚期角膜塑形进行评估。IVCM证实,CXL是一种安全的手术过程,并且仍然在不断发展并调整中。

In vivo confocal microscopy (IVCM) findings of 84 patients who had undergone conventional epithelium-off corneal collagen crosslinking (CXL) and accelerated CXL (ACXL) were retrospectively reviewed. Analysis confirmed that despite a significant decrease in the mean density of anterior keratocytes in the first 6 postoperative months, cell density after CXL and ACXL returned to baseline values at 12 months. The demarcation lines observed after treatments represent an expression of light-scattering (reflectivity changes) through different tissue densities. Temporary haze of the anterior-mid stroma after conventional CXL represents an indirect sign of CXL-induced stromal collagen compaction and remodeling. IVCM showed that treatment penetration varies to some extent, but that the endothelium is not damaged and is correlated with CXL biomechanical effects. IVCM of limbal structures shows no evidence of pathological changes. Regeneration of subepithelial and stromal nerves was complete 12 months after the operation with fully restored corneal sensitivity and no neurodystrophic occurrences. IVCM allowed detailed high magnification in?vivo micromorphological analysis of corneal layers, enabling the assessment of early and late corneal modifications induced by conventional and accelerated CXL. IVCM confirms that CXL is a safe procedure, which is still undergoing development and protocol adjustments.
 

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