穿透性角膜移植术后共焦显微镜下角膜移植片内皮细胞核异常显现的临床分析

发布时间：2018-06-06 22:15

本文选题：穿透性角膜移植 + 活体共焦显微镜　；参考：《浙江大学》2012年硕士论文

【摘要】：目的应用活体共焦显微镜观察穿透性角膜移植(Penetrating Keratoplasty,PKP)术后角膜移植片内皮细胞的形态学变化,研究术后角膜移植片内皮细胞核异常显现的共焦显微镜图像特征及变化规律,探讨该现象发生的影响因素、临床意义和可能机制。资料和方法回顾性病例研究。收集了自1999年4月至2008年4月期间在邵逸夫医院眼科首次接受PKP手术治疗,且术后规律随访超过一年的患者的临床资料。在术后随访期间,定期记录共焦显微镜的检查图像,分析角膜移植片内皮细胞核异常显现患者的内皮细胞和细胞核的形态学变化,以及内皮细胞的密度、面积、六边形细胞比例、面积多形性变异率和内皮细胞的丢失率。对术后角膜移植片的存活状态,术后并发症及再次手术的情况进行分析和统计学处理。结果符合纳入标准的病例共94例94眼,术后平均随访时间为11.2±15.2月。94例患者术后1个月时角膜移植片内皮细胞平均密度为2365.1±313.6个/mm2,细胞排列规则、大小均匀,共焦显微镜下观察不到角膜内皮细胞的细胞核。随访期间,角膜内皮细胞密度和六边形细胞的比例逐渐减少,细胞的面积增大。部分患者的角膜移植片内皮细胞核的形态发生改变,由正常情况下共焦显微镜观察不到内皮细胞核到异常显现细胞核的反光。到末次随访时,共有16例(16/94,17.0%)患者共焦显微镜下观察到角膜移植片内皮细胞核的反光,其中男性9例,女性7例,平均年龄为41.3±14.5岁。共焦显微镜下首次观察到角膜移植片内皮细胞核异常显现的平均时间为术后26.2±11.6月,检查发现角膜内皮细胞面积增大、多边多形,内皮细胞内可透见明亮的细胞核反光,异常显现的内皮细胞核呈球形或卵形,大小约为10-12μm。部分细胞面积增大的内皮细胞内出现多个细胞核的反光。首次观察到移植片内皮细胞核异常显现时患者的平均内皮细胞密度为878.2±193.9个/mm2,细胞面积为1140.3±296.4μm2,六边形细胞比例为32.6±12.1%,面积多形性变异率为46.8±9.7%,内皮细胞丢失率为61.6±16.8%,与术后角膜移植片内皮细胞核未显现患者末次随访的结果比较差异有统计学意义(P0.05,Mann-Whitney U Test).对PKP术后共焦显微镜下角膜移植片内皮细胞核异常显现进行Cox危险因素分析,发现与术后继发性青光眼、排斥反应和再次手术的发生在统计学上有相关性。结论本研究首次分析了PKP术后角膜移植片内皮细胞核异常显现的共焦显微镜图像特征、变化规律及其影响因素。PKP术后角膜移植片内皮细胞密度下降到900个/mm2以下,角膜内皮细胞形态结构会发生异常改变,呈现出细胞核的反光,这一现象是否预示角膜内皮细胞整体代偿功能接近临界状态,需进一步的研究。
[Abstract]:Objective to observe the morphologic changes of corneal allograft endothelial cells after penetrating keratoplasty with confocal microscopy in vivo, and to study the morphologic characteristics and changes of the abnormal nuclear appearance of corneal grafts after keratoplasty. To investigate the influencing factors, clinical significance and possible mechanism of this phenomenon. The clinical data of patients who received PKP surgery for the first time from April 1999 to April 2008 in Shaw Hospital and followed up regularly for more than one year were collected. During the follow-up period, the confocal microscope images were recorded regularly, and the morphologic changes of endothelial cells and nuclei, density and area of endothelial cells were analyzed. Hexagon cell ratio, area pleomorphic variation rate and endothelial cell loss rate. The survival status, postoperative complications and reoperation of corneal graft were analyzed and statistically analyzed. The mean follow-up time was 11.2 卤15.2 months. The average density of corneal endothelial cells was 2365.1 卤313.6 / mm ~ (2) at one month after operation. The cell arrangement was regular and the size of corneal endothelial cells was uniform. The nucleus of corneal endothelial cells could not be observed under confocal microscope. During the follow-up period, the density of corneal endothelial cells and the ratio of hexagonal cells decreased gradually, and the area of cells increased. The morphologic changes of endothelial nuclei in corneal grafts of some patients were observed under normal confocal microscope, and the abnormal reflex of endothelial nuclei was observed under confocal microscope. At the last follow-up, a total of 16 cases (16 / 94 卤17.0) of corneal graft endothelial nuclei were observed under a confocal microscope, including 9 males and 7 females, with an average age of 41.3 卤14.5 years. Under confocal microscope, the average time of abnormal appearance of corneal endothelial cells was 26.2 卤11.6 months postoperatively. It was found that the area of corneal endothelial cells was enlarged, the shape of corneal endothelial cells was polymorphic, and bright nuclear reflection could be seen in the endothelial cells. The abnormal endothelial nuclei were spherical or ovoid, about 10-12 渭 m in size. A number of nuclei reflected in endothelial cells with increased cell area. For the first time, the mean density of endothelial cells, cell area, hexagonal cell ratio, area and area of endothelial cells were 878.2 卤193.9 / m2, 32.6 卤12.1, 46.8 卤9.7 and 61.6 卤16.8mm ~ (-2), respectively, and the mean density of endothelial cells was 878.2 卤193.9 / mm ~ (-2), respectively, and the percentage of hexagonal cells was 32.6 卤12.1mm ~ (-2), respectively, and the loss rate of endothelial cells was 61.6 卤16.8%. There was a statistically significant difference in the results of the last follow-up in the patients without nuclear endothelial cells in corneal allograft (P 0.05) Mann-Whitney U test. Cox analysis of abnormal appearance of endothelial nucleus in corneal allograft under confocal microscopy after PKP was carried out, and secondary glaucoma was found after PKP. There is a statistical correlation between rejection and reoperation. Conclusion this study is the first time to analyze the confocal microscopy features of abnormal nuclear appearance of corneal graft endothelial cells after PKP. The density of corneal allograft endothelial cells decreased to less than 900 / mm2 after PKP, the morphology and structure of corneal endothelial cells changed abnormally, showing nuclear reflectance. Whether this phenomenon indicates that the overall compensatory function of corneal endothelial cells is close to the critical state needs further study.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.65

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