长期使用前列腺素类滴眼液对角膜结构与知觉的影响  

Corneal morphology and sensitivity changes induced by the long-term application of topical prostaglandin analogs

作　　者：崔心瀚[1] 周晓东[1] 徐建江[2] 乐琦骅[2] 项俊[2] 朱文卿[2] 孔祥梅[2] 戴毅[1] 

机构地区：[1]复旦大学附属金山医院眼科,上海201508 [2]复旦大学附属眼耳鼻喉,上海200031

出　　处：《中华眼视光学与视觉科学杂志》2013年第6期365-369,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：基金项目：上海市卫生局科研课题（20114122）

摘　　要：目的探讨青光眼患者长期使用前列腺素类滴眼液对角膜结构与知觉的影响。方法横断面对照研究。收集2011年8月至2012年4月期间在复旦大学附属眼耳鼻喉科医院就诊的原发性开角型青光眼患者20例（40眼），分为2组：A组为使用前列腺素类滴眼液1年以上且半年内用药方案未改变患者10例（20眼）；B组为初诊未用药患者10例（20眼）。所有患者使用Cochet ＆ Bonnet角膜知觉仪测量角膜知觉，使用激光活体共聚焦显微镜观察角膜上皮下神经纤维及上皮、基质、内皮细胞形态，记录并分析图像。组间采用双眼设计模型进行方差分析，角膜知觉与上皮下神经、炎症细胞、朗格罕细胞等的关系进行Spearman相关分析。结果与B组比，A组角膜上皮基底层细胞密度明显较高[（7009±638）个]mm2uS．（6745±482）个]mm2；F=5．22，P〈0．05]，上皮下神经纤维分支明显较少[（17．44±2．56）mm／mm2us．（19．54±5．02）mm／mm2；F=8．22，P〈0．05]、神经扭曲度较高[（1．71±0．46）us.（1．42±0．43）；F=7．29，P〈0．051，角膜基质细胞激活态分级明显较高[（2．35±0．81）us．（1．25±0．44）；F=59．67，P〈0．01]，角膜知觉明显较低[（54．25±6．74）mmus（59．50±1．54）mm；F=12．08，P〈0．01]。角膜上皮下神经纤维密度及反光度、朗格罕细胞及炎症细胞浸润量、角膜内皮细胞形态未见明显改变。角膜知觉与角膜上皮下神经纤维密度呈正相关（r=0．379，P〈0．05），与角膜上皮下神经分支数、扭曲度、反光度及炎症细胞、朗格罕细胞浸润无明显相关性。结论长期使用前列腺素类滴眼液可引起角膜深达基质层细胞的形态学变化和角膜知觉下降．知觉下降与角膜上皮下神经纤维密度减少有关。Objective To evaluate the corneal morphology and corneal mechanical sensitivity in patients under long-term prostaglandin analog treatment. Methods A cross-sectional case-control study was performed in the Eye and ENT Hospital of Fudan University from August 20ll to April 2012. A total of 20 patients with bilateral primary open-angle glaucoma were enrolled, including 10 patients treated with prostaglandin eye drops for at least one year with an unchanged prescription during the final 6 months （group A）, and 10 untreated patients （group B）. Corneal sensitivity was assessed using the Cochet ＆ Bonnet esthesiometer. Corneal morphology was examined with an in vivo confoeal microscope. A two-eye design model was used to evaluate the differences between the two groups. A Spearman correlation coefficient was used to analyze the relationship between corneal sensitivity and corneal subbasal cells. Results The corneal basal epithelial cell density of group A was significantly higher than that of group B [（7009±638）个]mm2uS.（6745±482）个]mm2;F=5.22,P〈0.05], Results were similar for the tortuosity of corneal subbasal nerves（1.71±0.46us.1.42±0.43;F=7.29,P〈0.05）and the grade for activated keratocyter [（2.35±0.81）us.（1.25±0.44）;F=59.67,P〈0.01],In contrast,the branches of the corneal subbasal nerves（17.44±2.56mm/mm2us.19.54±5.02mm/mm2;F=8.22,P〈0.05）and corneal sensitivity （54.25±6.74mmus.59.50±1.54mm;F=12.08,P〈0.01）were significantly reduced in group A. The corneal endothelium did not present any morphological abnormalities. The reduced corneal sensitivity positively correlated with the density of the corneal subbasal nerves （r=0.379, P〈0.05）. No correlations were found between corneal sensitivity and other factors such as tortuosity, reflectivity of subbasal nerves, the density of Langerhans cells or inflammatory cells. Conclusion Significant morphological alterations in the cornea were found in glaucomatous patients with chronic prostaglandin analog treatment, exc

关 键 词：显微镜检查 共焦 防腐剂 制药学 青光眼 角膜 

分 类 号：R77[医药卫生—眼科]