活体共聚焦显微镜在眼前段疾病诊治中的应用进展
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摘要
活体共聚焦显微镜(IVCM)是一种被广泛应用于研究活体眼表组织结构特征与功能变化的非侵入性图像诊断技术,可作为观察眼表组织在细胞水平的损伤以及纵向监测其修复过程的方式。近年来越来越多的研究使用IVCM分析眼部疾病的病理变化过程尤其是眼前段疾病。在角膜炎的鉴别、角膜营养不良的分型、角膜神经的再生修复、睑板腺和眼表疾病的评估、肿瘤疾病的早期诊断、青光眼的手术评价等方面IVCM均发挥一定作用。IVCM因能快速获取高分辨率图像和微观结构,其临床应用仍在不断向更多疾病的诊治扩展。
In vivo confocal microscopy( IVCM) has become a widely accepted non-invasive imaging technique to study the structural features and functional changes of anterior segment. It provides a unique opportunity to visualize the ocular surface tissue at the cellular level without damage and realize longitudinal monitoring of the recovery process. In recent years there is a growing literature analyzing the pathological changes of ocular disease,especially many anterior segment diseases.IVCM plays a role in differentiation of corneal dystrophies types,corneal nerve injury assessment,diagnosing corneal and conjunctival inflammatory,early diagnosis of neoplastic diseases,evaluating glaucoma surgical treatment and so on. Its clinical application continues to expand into the diagnosis and treatment of more diseases due to its rapid acquisition of highresolution images and microstructure.
In vivo confocal microscopy( IVCM) has become a widely accepted non-invasive imaging technique to study the structural features and functional changes of anterior segment. It provides a unique opportunity to visualize the ocular surface tissue at the cellular level without damage and realize longitudinal monitoring of the recovery process. In recent years there is a growing literature analyzing the pathological changes of ocular disease,especially many anterior segment diseases.IVCM plays a role in differentiation of corneal dystrophies types,corneal nerve injury assessment,diagnosing corneal and conjunctival inflammatory,early diagnosis of neoplastic diseases,evaluating glaucoma surgical treatment and so on. Its clinical application continues to expand into the diagnosis and treatment of more diseases due to its rapid acquisition of highresolution images and microstructure.
引文
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[2]Niederer RL,Mcghee CN.Clinical in vivo confocal microscopy of the human cornea in health and disease[J].Prog Retin Eye Res,2010,29(1):30-58.
[3]You JY,Botelho PJ.Corneal In Vivo Confocal Microscopy:Clinical Applications[J].R I Med J,2013,2016,99(6):30-33.
[4]Hernández-Quintela E,Mayer F,Dighiero P,et al.Confocal microscopy of cystic disorders of the corneal epithelium[J].Ophthalmology,1998,105(4):631-636.
[5]余晨颖,李莹.活体共聚焦显微镜在干眼患者眼表形态观察中的应用[J].中华眼视光学与视觉科学杂志,2014,16(9):573-576.
[6]徐建江,李一敏.眼表活体共聚焦显微镜的临床应用进展[J].中国眼耳鼻喉科杂志,2012,12(b12):447-450.
[7]Kumar RL,Cruzat A,Hamrah P.Current state of in vivo confocal microscopy in management of microbial keratitis[J].Semin Ophthalmol,2010,25(5/6):166-170.
[8]Wang Y,Le Q,Zhao F,et al.Application of in vivo laser scanning confocal microscopy for evaluation of ocular surface diseases:Lessons learned from pterygium,meibomian gland disease,and chemical burns[J].Cornea,2011,30 Suppl 1:S25-28.
[9]Nguena MB,van den Tweel JG,Makupa W,et al.Diagnosing ocular surface squamous neoplasia in East Africa:Case-control study of clinical and in vivo confocal microscopy assessment[J].Ophthalmology,2014,121(2):484-491.
[10]Kymionis GD,Diakonis VF,Shehadeh MM,et al.Anterior segment applications of in vivo confocal microscopy[J].Semin Ophthalmol,2015,30(4):243-251.
[11]孙旭光.活体角膜激光共聚焦显微镜图谱[M].北京:人民军医出版社,2014:2-6.
[12]Cavanagh HD,Jester JV,Essepian J,et al.Confocal microscopy of the living eye[J].CLAO J,1990,16(1):65-73.
[13]Paddock SW,Eliceiri KW.Laser scanning confocal microscopy:History,applications,and related optical sectioning techniques[J].Methods Mol Biol,2014,1075:9-47.
[14]Kheirkhah A,Syed ZA,Satitpitakul V,et al.Sensitivity and specificity of laser-scanning in vivo confocal microscopy for filamentous fungal keratitis:Role of observer experience[J].Am J Ophthalmol,2017,179:81-89.
[15]Chidambaram JD,Prajna NV,Larke N,et al.In vivo confocal microscopy appearance of Fusarium and Aspergillus species in fungal keratitis[J].Br J Ophthalmol,2017,101(8):1119-1123.
[16]Garg P.Investigative modalities in infectious keratitis[J].Indian J Ophthalmol,2009,57(2):159.
[17]Kanavi MR,Javadi M,Yazdani S,et al.Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis[J].Cornea,2007,26(7):782-786.
[18]Ledbetter EC,Norman ML,Starr JK.In vivo confocal microscopy for the detection of canine fungal keratitis and monitoring of therapeutic response[J].Vet Ophthalmol,2016,19(3):220-229.
[19]Müller RT,Abedi F,Cruzat A,et al.Degeneration and regeneration of subbasal corneal nerves after infectious keratitis:A longitudinal in vivo confocal microscopy study[J].Ophthalmology,2015,122(11):2200-2209.
[20]Rezaei KM,Naghshgar N,Javadi MA,et al.Various confocal scan features of cysts and trophozoites in cases with Acanthamoeba keratitis[J].Eur J Ophthalmol,2012,22 Suppl 7(Suppl 7):S46-50.
[21]Chidambaram JD,Prajna NV,Larke NL,et al.Prospective study of the diagnostic accuracy of the in vivo laser scanning confocal microscope for severe microbial keratitis[J].Ophthalmology,2016,123(11):2285-2293.
[22]梁庆丰,孙旭光,LABBE Antoine.活体共聚焦显微镜在感染性角膜炎诊治中的应用[J].中华眼科杂志,2013,49(10):951-955.
[23]LabbéA,Khammari C,Dupas B,et al.Contribution of in vivo confocal microscopy to the diagnosis and management of infectious keratitis[J].Ocul Surf,2009,7(1):41-52.
[24]Hau SC,Dart JK,Vesaluoma M,et al.Diagnostic accuracy of microbial keratitis with in vivo scanning laser confocal microscopy[J].Br JOphthalmol,2010,94(8):982-987.
[25]Farooq AV,Shukla D.Herpes simplex epithelial and stromal keratitis:An epidemiologic update[J].Surv Ophthalmol,2012,57(5):448-462.
[26]Hillenaar T,Weenen C,Wubbels RJ,et al.Endothelial involvement in herpes simplex virus keratitis:An in vivo confocal microscopy study[J].Ophthalmology,2009,116(11):2077-2086.
[27]余晓菲,王丽娅,张月琴.不同类型单疱病毒性角膜炎角膜内细胞变化共聚焦显微镜观察[J].中国实用眼科杂志,2015,33(3):245-249.
[28]Dighiero P,Ellies P,Grateau G,et al.Review on corneal dystrophies[J].J Fr Ophtalmol,1999,22(2):226-233.
[29]Tuft S,Bron AJ.Imaging the microstructural abnormalities of Meesmann corneal dystrophy by in vivo confocal microscopy[J].Cornea,2006,25(7):868-870.
[30]Kobayashi A,Sakurai M,Shirao Y,et al.In vivo confocal microscopy and genotyping of a family with Thiel-Behnke(honeycomb)corneal dystrophy[J].Arch Ophthalmol,2003,121(10):1498-1499.
[31]Kobayashi A,Sugiyama K.In vivo laser confocal microscopy findings for Bowman's layer dystrophies(Thiel-Behnke and Reis-Bucklers corneal dystrophies)[J].Ophthalmology,2007,114(1):69-75.
[32]Bailly N,Sherif ZA,Pleyer U,et al.Confocal microscopy in corneal dystrophies:A comparison between confocal slit scanning(Confo S-can P2)and laser scanning microscopy(Rostock Cornea ModulHRTⅡ)[J].Klin Monbl Augenheilkd,2006,223(9):735-742.
[33]Kobayashi A,Fujiki K,Fujimaki T,et al.In vivo laser confocal microscopic findings of corneal stromal dystrophies[J].Arch Ophthalmol,2007,125(9):1168-1173.
[34]Kailasanathan A,Maharajan S.In vivo confocal microscopy detects preclinical corneal lattice dystrophy[J].Eye,2013,27(8):991-992.
[35]Dalton K,Schneider S,Sorbara L,et al.Confocal microscopy and optical coherence tomography imaging of hereditary granular dystrophy[J].Cont Lens Anterior Eye,2010,33(1):33-40.
[36]Kontadakis GA,Kymionis GD,Kankariya VP,et al.Corneal confocal microscopy findings in sporadic cases of pre-descemet corneal dystrophy[J].Eye Contact Lens,2014,40(2):e8-12.
[37]Grupcheva CN,Malik TY,Craig JP,et al.Microstructural assessment of rare corneal dystrophies using real-time in vivo confocal microscopy[J].Clin Exp Ophthalmol,2001,29(5):281-285.
[38]Holopainen JM,Moilanen JA,Tervo TM.In vivo confocal microscopy of Fleck dystrophy and pre-Descemet's membrane corneal dystrophy[J].Cornea,2003,22(2):160-163.
[39]Chiou AG,Kaufman SC,Beuerman RW,et al.Confocal microscopy in cornea guttata and Fuchs'endothelial dystrophy[J].Br JOphthalmol,1999,83(2):185-189.
[40]Kaufman SC,Beuerman RW,Kaufman HE.Diagnosis of advanced fuchs'endothelial dystrophy with the confocal microscope[J].Am J Ophthalmol,1993,116(5):652-653.
[41]Babu K,Murthy KR.In vivo confocal microscopy in different types of posterior polymorphous dystrophy[J].Indian J Ophthalmol,2007,55(5):376-378.
[42]Bozkurt B,Irkec M,Mocan MC.In vivo confocal microscopic findings in posterior polymorphous corneal dystrophy[J].Cornea,2013,32(9):1237-1242.
[43]Grupcheva CN,Chew GS,Edwards M,et al.Imaging posterior polymorphous corneal dystrophy by in vivo confocal microscopy[J].Clin Exp Ophthalmol,2010,29(4):256-259.
[44]Nishida T,Chikama T,Sawa M,et al.Differential contributions of impaired corneal sensitivity and reduced tear secretion to corneal epithelial disorders[J].Jpn J Ophthalmol,2012,56(1):20-25.
[45]郑斌,毕延峰,陈岩,等.共聚焦显微镜观察眼钝挫伤患者角膜基底下神经丛组织形态学变化[J].中华眼科杂志,2014,50(8):584-588.
[46]Murphy P,Patel S,Marshall J.The effect of long-term,daily contact lens wear on corneal sensitivity[J].Cornea,2001,20(3):246-249.
[47]韩时超,李艳,崔传波,等.飞秒激光制瓣LASIK术后角膜神经再生的激光扫描共焦显微镜观察[J].中华实验眼科杂志,2013,32(11):1074-1078.
[48]余晨颖,李莹.共聚焦显微镜在LASIK术后角膜检查中的应用[J].中华眼视光学与视觉科学杂志,2013,15(5):271-275.
[49]Calvillo MP,Mclaren JW,Hodge DO,et al.Corneal reinnervation after LASIK:Prospective 3-year longitudinal study[J].Invest Ophthalmol Vis Sci,2004,45(11):3991-3996.
[50]Chang PY,Carrel H,Huang JS,et al.Decreased density of corneal basal epithelium and subbasal corneal nerve bundle changes in patients with diabetic retinopathy[J].Am J Ophthalmol,2006,142(3):488-490.
[51]Nowińska A,Wylega?a E,Tarnawska D,et al.Meibomian gland dysfunction-review[J].Klin Oczna,2012,114(2):147-152.
[52]Ibrahim OM,Matsumoto Y,Dogru M,et al.The efficacy,sensitivity,and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction[J].Ophthalmology,2010,117(4):665-672.
[53]Lin H,Li W,Dong N,et al.Changes in corneal epithelial layer inflammatory cells in aqueous tear-deficient dry eye[J].Invest Ophthalmol Vis Sci,2010,51(1):122-128.
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