瘢痕性角結膜疾患における結膜上皮の異常性

Abnormality of conjunctival epithelial cells in cicatricial ocular surface diseases

　Impression cytologyを用いて瘢痕性角結膜上皮疾患の結膜上皮の異常性を杯細胞頻度を指標として検討した．杯細胞頻度は（—），（±），（＋），（⧺）の4段階に分類した．（—）は杯細胞を認めず，角化した上皮を認めたもの，（±）は結膜上皮1mm²あたり0〜10個を杯細胞を認めたもの，（＋）は結膜上皮1mm²あたり10〜100個の杯細胞を認めたもの，（⧺）は結膜上皮1mm²あたり100〜1,000個の杯細胞を認めたものとした．対照である白内障術前の眼では，（±）が1眼，（＋）が6眼であるのに対して，瘢痕期の熱化学腐蝕眼では，（±）が2眼，（＋）が5眼，（⧺）が4眼であり，Stevens-Johnson症候群では，（—）が4眼，（±）が2眼，（＋）が1眼であった．眼類天疱瘡では，（—）が2眼，（±）が2眼で（＋）と（⧺）は認められなかった．原因不明の瘢痕性角結膜上皮疾患では，（±）3眼，（＋）5眼であった．瘢痕期の熱化学腐蝕10例11眼のうち，健眼からも標本を得られた5例について，患眼と健眼の杯細胞数を比較すると，全ての症例において患眼の方が健眼よりも多数の杯細胞を認めた．同じような臨床的所見を示す疾患においても，結膜上皮の異常に関して差異があり，病理学的な検査が必要と考えられた．

We evaluated the conjunctival epithelial cells in cicatricial diseases of the cornea and the conjunc-tiva including thermochemical burn 11 eyes, Stevens-Johnson syndrome 7 eyes, ocular pemphigoid 4 eyes and idiopathic cicatricial diseases 8 eyes. Seven otherwise healthy cataractous eyes served as con-trol. We tentatively defined 4 cytological stages based on goblet cell density. Stage (-) indicates keratinized epithelial cells with no goblet cells. In stage (±), there were 0 to 10 goblet cells per square millimeters.Stages (+) and (⧺) indicated 10 to 100 and 100 to 1,000 goblet cells respectively.Eyes following thermochemical injuries formed a distinct group as there were 4 eyes (36%) belongingto stage (⧺). All the other diseases either belonged to stage (-), (±) or (+) and were similar to the control eyes.

We examined biopsied conjunctival specimen from both eyes in 5 unilateral cases of theremo-chemical injuries. The goblet cell density was signi-ficantly greater in the injured eye than in the fellow, normal eye in all the 5 pairs (p< 0.05). The findings suggest the possibility that different abnormalities in conjunctival epithelial cells may exist in ocular surface diseases even when they manifest similar clinical manifestations. Impression cytology promises to be of value in accurate diagno-sis and in planning therapeutic approach in cicatricial ocular surface diseases.

Rinsho Ganka (Jpn J Clin Ophthalmol) 46(7) : 733-736, 1987