Study Of The Chamber Angle Synechia Mechanism Of Chandler Syndrome

Objective:1. Study the situation of corneal endothelial cell of the patients with Chandlersyndrome and Fuchs endothelial dystrophy under confocal microscope and discuss the clinicalfeatures of the Chandler syndrome under confocal microscope;2. Determine the clinicalapplication values of confocal microscope to change the diagnosis of chamber angle in theChandler syndrome through comparing the protrusion distribution of the corneal endothelial cellin each quadrant of the patients with Chandler syndrome and Fuchs endothelial dystrophy;3. Further study and analyze the chamber angle synechia of Chandler syndrome by combiningthe examinations through UBM, AS-OCT and Pentacam scheimpflug photography system, etc;4. In combination with the study results described above, discuss the method to increase thediagnosis rate of Chandler syndrome and provide basis for the correct disease diagnosis and cure.Methods:1. Carry out examinations to27patients with Chandler syndrome (27eyes) and16patients with Fuchs endothelial dystrophy (27eyes) through confocal microscope, and thenmeasure and analyze by NAviS software the tapering protrusion of the corneal endothelial cellin addition to comparison.2. Carry out UBM, corneal topography and AS OCT examinationsrespectively to the27patients with Chandler syndrome (27eyes) and16patients with Fuchsendothelial dystrophy (27eyes) to further observe the morphological characteristics of theChandler syndrome.Results：1. Under confocal microscope, both groups of patients have tapering protrusion inconceal endothelial cells but in different distributions, among which, the tapering protrusions ofthe conceal endothelial cells in01-04quadrants are respectively72.48±12.20um,71.52±10.87um,72.11±10.84um and73.00±11.11um, apparently increased compared to the61.00±18.94um,59.30±16.46um,55.07±20.48um and50.33±19.92um in01-04quadrants ofFuch’s endothelial dystrophy. The results of the t test show that difference between bothdiseases is of the statistical significance (P<0.05, table5); the tampering protrusion of thesurrounding endothelial cells in the group of Chandler syndrome increases obviously than thecentral part and it is of statistical significance found through test (P<0.05, refer to Table3, Fig.7and9); the tampering protrusion of the central endothelial cells in the group of Chandlersyndrome is lower than that of the group of Fuch’s endothelial dystrophy, which is of statistical significance after test (P<0.05, Table4), and; the difference of the tampering protrusionbetween central and surrounding endothelial cellsin the group of Fuch’s endothelial dystrophyhas no statistical significance (P>0.05, refer to Table6, Fig.8and10).2. Under UBM, itshows surrounding anterior iris synechia, anterior chamber angle disappearing and chamberangle closing of different degrees (Fig.14and15). The patient with Fuch’s endothelialdystrophy has conceal edema and less smooth endothelial echo, but doesn’t have obvioussurrounding iris synechia and chamber closing (Fig.16).3. Under AS-OCT, the first patient hasconceal edema, thickening, and the surrounding iris synechia as well as nearly fully closedchamber angle (Fig.17and18), while the second patient presents conceal edema without anychange in corneal endothelium, iris and chamber angle (Fig.19).4. Under Pentacamthree-dimensional scheimpflug photography system, the former presents tissue adhesion aroundthe back surface of cornea (Fig.21and22), while the latter has no obvious change (Fig.23).Conclusion：1.Under confocal microscope, both the patients with Chanlder syndrome andFuch’s endothelial dystrophy have the tapering protrusion in the conceal endothelial cells but indifferent distributions. The tapering protrusion in the conceal endothelial cell of the patient withChandler syndrome lies in the lower middle part of the conceal with surrounding part muchhigher, while the tapering protrusion in the conceal endothelial cell of the patient with Fushsendothelial dystrophy distributes evenly in cornea.2.We presume that such distributiondifference is easy to cause obvious tapering anterior synechia to the patient with Chandlersyndrome, while the patient with Fuch’s endothelial dystrophy doesn’t have any taperinganterior synechia, which may be one of the major mechanisms that the patient with Chandlersyndrome has tapering anterior synechia.3.We observed the changes in the structural form ofeach layer of cornea and iris synechia through AS-OCT, UBM and Pentacam, but cannotobserve and measure the tapering protrusion of the conceal endothelial cell, so confocalmicroscope plays an important role in the diagnosis and treatment of Chandler syndrome.