以活體共軛焦顯微鏡探討眼角膜傷口癒合

Abstract

在人類及獸醫眼科學中，眼角膜細胞的再生與修復在眼角膜傷口的癒合上扮演著重要的角色，活體共軛焦顯微鏡為一非侵入式的儀器，可以用來了解眼角膜傷口癒合過程中細胞的變化，本研究中的糖尿病病人接受玻璃體切除術前，會先施行眼角膜上皮清創步驟，活體共軛顯微鏡用以觀察並記錄術前、術後一週、兩週、三週、四週、三個月、六個月，眼角膜細胞及神經型態變化，觀察眼角膜基底上皮細胞、表層上皮細胞、基質層、內皮細胞、基底層下神經的型態，也以量化方式對內皮細胞進行細胞密度計算。在術後一個月、三個月、六個月，基底上皮癒合不全的比例為72.1%、15.2% 、0%，表層上皮癒合不全的比例為81.1%、9.1%、0%，結果顯示糖尿病患角膜再生過程較正常個體緩慢，基底層下神經彎曲的型態變化在糖尿病病人跟STZ誘發糖尿病症大鼠的活體共軛焦顯微鏡，皆可觀察到。

Corneal regeneration plays an important role in corneal wound healing in human and veterinary ophthalmology. In vivo confocal microscopy was used to observe the corneal epithelial cells during corneal wound healing. In the present study, the corneal wounds of diabetic patients who underwent corneal epithelial debridement during pars plana vitrectomy for proliferative diabetic retinopathy were investigated. In vivo confocal microscopy was used to evaluate images of the corneal basal and apical surface epithelial cells before surgery weekly for the first month, and at the third and sixth month after surgery, respectively. In vivo confocal microscopy showed incomplete healing of basal epithelial cells in 72.1%, 15.2%, and 0% of eyes and incomplete healing of surface apical epithelial cells in 81.1%, 9.1%, and 0% of eyes at 1, 3, and 6 months after surgery, respectively. The tortuous morphology of subbasal corneal nerves were observed in diabetic patients and STZ-induced diabetic rats. The results revealed the slower corneal regeneration process in the diabetic patients than non-diabetic patients.