激光共聚焦显微镜在棘阿米巴角膜炎诊疗中的应用（附病例报告）

发布时间：2018-10-19 20:31

【摘要】：目的：研究激光共聚焦显微镜HRT3-RCM在棘阿米巴角膜炎诊断中的应用,比较分析与传统诊疗办法相比,该方法的优缺点,探讨在治疗过程中作为随诊观察治疗效果手段的意义。方法：收集以往临床确诊棘阿米巴性角膜炎患者5例(5眼)的病历资料,对比病人共聚焦显微镜检查,及角膜刮片细菌、真菌镜检与培养及阿米巴原虫镜检的结果。并按照患者入院确诊时的裂隙灯表现区分为早期患者和晚期患者,探讨使用共聚焦显微镜检查对于早期发现及治疗过程随访的重要意义。结果：5患者中,4例患者裂隙灯检查见角膜混浊、浸润,基质雾状水肿,后弹力层皱褶,角膜溃疡形成；1患者表现为典型角膜基质环形浸润。角膜刮片镜检及培养均无阳性病例。HRT3-RCM显示棘阿米巴包囊位于角膜上皮下或浅层基质150μm以内,1例患者角膜内查见多个包囊,余均见1个包囊,包囊形态为圆形至椭圆形高回声结构,双层囊壁,大小为25-150μm,多为60μm左右,内核形态类圆形。药物治疗过程中,2例患者包囊形态发生改变,为包囊变小,双层囊壁结构不清。1例患者治疗12周后HRT3-RCM检查包囊消失、基质炎症减退。患者临床症状的加重与缓解与患者的就诊时间及感染原虫数目有关。结论：共焦显微镜,是一种快速无创的检查方法,实时活体检查,具有高清晰度及分辨率、确切的深度定位、时间动态观察、纵向断层扫描等优势,可作为棘阿米巴性角膜炎病原学诊断及疗程中随访观察的重要辅助检查手段。早期明确的诊断对于棘阿米巴角膜炎患者是否痊愈以及病程的长短具有重要意义,而共聚焦显微镜是当前重要的早期快速确诊角膜炎类型的辅助检查之一。
[Abstract]:Objective: to study the application of laser confocal microscope (HRT3-RCM) in the diagnosis of Acanthamoeba keratitis. Methods: 5 cases (5 eyes) of Acanthoamoeba keratitis were collected and compared with the results of confocal microscope, corneal scraping bacteria, fungal microscopy and amoeba protozoa. According to the slit-lamp findings of admission, the patients were divided into early and late stage patients. The significance of confocal microscopy in early detection and follow-up was discussed. Results: in 5 cases, 4 cases showed corneal opacity, infiltration, matrix fog edema, posterior elastic layer fold, corneal ulcer formation, 1 typical corneal stroma ring infiltration. HRT3-RCM showed that Acanthamoeba cyst was located within 150 渭 m of the corneal subcutaneous or superficial stroma. In one case, multiple cysts were found in the cornea, and 1 cyst was found in the rest. The shape of the cyst is round to elliptical hyperechoic structure, double layer wall, 25-150 渭 m in size, mostly about 60 渭 m, and the core is round in shape. In the course of drug therapy, the cystic morphology was changed in 2 cases, the cyst became smaller and the structure of double layer cyst wall was unclear. After 12 weeks of treatment, HRT3-RCM examination disappeared and matrix inflammation decreased in 1 patient. The exacerbation of clinical symptoms was related to the time of visit and the number of infected protozoa. Conclusion: confocal microscope is a rapid and noninvasive examination method with high definition and resolution, precise depth location, time dynamic observation, longitudinal tomography and so on. It can be used as an important auxiliary examination for etiological diagnosis and follow-up observation of Acanthamoeba keratitis. Early and definite diagnosis is of great significance for the recovery and duration of the disease in patients with Acanthamoeba keratitis. Confocal microscopy is one of the most important assistant examinations for the early and rapid diagnosis of keratitis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R772.21

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