In Vivo Confocal Microscopy in Scarring Trachoma
In Vivo Confocal Microscopy in Scarring Trachoma
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DOI：
10.1016/j.ophtha.2011.04.014
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发表时间：
2011-11-01
期刊：
影响因子：
13.7
通讯作者：
Burton, Matthew J.
中科院分区：
文献类型：
--
作者：
Hu, Victor H.;Weiss, Helen A.;Burton, Matthew J.
目的：使用体内共聚焦显微镜 (IVCM) 表征沙眼疤痕 (TS) 和炎症中发现的组织和细胞变化。设计：两项免费病例对照研究。参与者：第一项研究包括 363 名 TS 病例（无倒睫），其中 328 名接受了 IVCM 评估，以及 363 名对照受试者，其中 319 名接受了 IVCM 评估。第二项研究包括 34 例沙眼倒睫 (TT) 病例，其中 28 例进行了 IVCM 评估，以及 33 名对照受试者，其中 26 例进行了 IVCM 评估。方法：所有参与者均使用 x2.5 放大镜进行检查。上睑结膜的 IVCM 检查使用带有罗斯托克角膜模块的海德堡视网膜断层扫描仪 3（海德堡工程有限公司，多森海姆，德国）进行。是否存在树突状细胞 (DC)、组织水肿和乳头；结果：具有临床疤痕的受试者在 IVCM 上具有特征性的外观，即可见清晰的带状和片状疤痕组织。在一些临床正常受试者中也观察到类似的变化，与亚临床疤痕一致。即使在调整了其他因素（包括临床炎症水平）后，有疤痕的受试者也有更多的树突状细胞和更高的炎症浸润。细胞活性通常仅在上皮内或正下方可见，很少在距离表面超过 30 μm 的深处可见。组织水肿的存在与临床炎症水平密切相关。结论：体内共聚焦显微镜可定量研究结膜的炎症和疤痕变化。树突状细胞似乎与沙眼的疤痕形成过程密切相关，并且可能是抗纤维化治疗或衣原体疫苗开发的重要靶标。在疤痕受试者中观察到的炎症细胞数量增加与该疾病的免疫病理学性质一致。细胞活动的定位靠近结膜表面，这支持了上皮在沙眼发病机制中发挥核心作用的观点。 财务披露：作者对本文讨论的任何材料没有专有或商业利益。眼科 2011；118:2138-2146 (C) 2011 年，美国眼科学会。
Objective: To characterize the tissue and cellular changes found in trachomatous scarring (TS) and inflammation using in vivo confocal microscopy (IVCM).Design: Two complimentary case-control studies.Participants: The first study included 363 cases with TS (without trichiasis), of whom 328 had IVCM assessment, and 363 control subjects, of whom 319 had IVCM assessment. The second study included 34 cases with trachomatous trichiasis (TT), of whom 28 had IVCM assessment, and 33 control subjects, of whom 26 had IVCM assessment.Methods: All participants were examined with x2.5 loupes. The IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany).Main Outcome Measures: The IVCM images were graded in a masked manner using a previously published grading system evaluating the inflammatory infiltrate density; the presence or absence of dendritiform cells (DCs), tissue edema, and papillae; and the level of subepithelial connective tissue organization.Results: Subjects with clinical scarring had a characteristic appearance on IVCM of well-defined bands and sheets of scar tissue visible. Similar changes were also seen in some clinically normal subjects consistent with subclinical scarring. Scarred subjects had more DCs and an elevated inflammatory infiltrate, even after adjusting for other factors, including the level of clinical inflammation. Cellular activity was usually seen only in or just below the epithelium, rarely being seen deeper than 30 mu m from the surface. The presence of tissue edema was strongly associated with the level of clinical inflammation.Conclusions: In vivo confocal microscopy can be quantitatively used to study inflammatory and scarring changes in the conjunctiva. Dendritic cells seem to be closely associated with the scarring process in trachoma and are likely to be an important target in antifibrotic therapies or the development of a chlamydial vaccine. The increased number of inflammatory cells seen in scarred subjects is consistent with the immunopathologic nature of the disease. The localization of cellular activity close to the conjunctival surface supports the view that the epithelium plays a central role in the pathogenesis of trachoma.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011;118:2138-2146 (C) 2011 by the American Academy of Ophthalmology.