应用共聚焦显微镜观察干眼病及配戴角膜接触镜对角膜上皮下神经密度影响  

The effects of dry eye disease and contact lenses on corneal sub-epithelial nerve density with in vivo confocal microscopy observation

作　　者：张栋[1] 胡亮[2] 陈佳[1] 余野[2] 余鹏[1] 瞿佳[1] 

机构地区：[1]温州医学院,浙江温州325027 [2]温州医学院附属眼视光医院

出　　处：《中国实用眼科杂志》2013年第6期704-708,共5页Chinese Journal of Practical Ophthalmology

基　　金：浙江省重点科技创新团队项目（2011R09039-09）;温州市科技局项目（Y20100199）;温州市重点科技创新团队项目（C20120009-03）;

摘　　要：目的探讨干眼病及配戴角膜接触镜对角膜上皮下神经的分布及密度的影响。方法根据患者Schirmer Ⅰ试验、TBUT（泪膜破裂时间）和角膜荧光染色情况将64例干眼患者（128只眼）分为Ⅰ级、Ⅱ级、Ⅲ级干眼组和非干眼组，各组根据配戴角膜接触镜的情况，分为戴镜组和非戴镜组两个亚组。应用海德堡HRT3I共聚焦显微镜观察患者三个方位（中央，颞侧，鼻侧）角膜上皮下神经，分析比较不同组间不同方位角膜上皮下神经密度的差异。结果角膜中央与颞侧上皮下神经密度（t=3．30，P=0．001）、角膜中央与鼻侧上皮下神经密度（t=7．34，P〈0．001）、角膜颞侧与鼻侧上皮下神经密度（t：4．05，P〈0．001），差异有统计学意义；Ⅰ级千眼戴镜组与II级干眼戴镜组角膜颞侧上皮下神经密度（t：2．27，P=0．026），差异有统计学意义；Ⅰ级干眼戴镜组与II级干眼戴镜组角膜鼻侧上皮下神经密度（t=2．72，P=0．008）存在差异有统计学意义。结论干眼病和配戴角膜接触镜是造成患者周边角膜（颞侧和鼻侧）上皮下神经密度发生改变的两个重要因素。Objective To investigate the effects on the changes of corneal subepithelial nerve dis- tribution and density by dry eye disease and contact lens wear. Methods One hundred and twen- ty-eight eyes of 64 patients were divided into Grade Ⅰ, Ⅱ, Ⅲ and None dry eye groups by scores of Schirmer Ⅰ test （SIT）, TBUT （tear break-up time） and Corneal fluorescein staining （RB）, and these groups were divided into two sub-groups： with wearing CL （contact lens） group and non-wear- ing CL group, according to whether contact lens wear. All patients were detected by confocal micros- copy （HRT/Ⅱ, Heidelberg） in three positions （the central, temporal and nasal of cornea）, and were compared the corneal sub-epithelial nerve density in different groups. Results The central of corne- al sub-epithelial nerve density （CCND） and the temporal of corneal sub-epithelial nerve density （TCND） （t =3.30, P =0.001）, CCND and the nasal of corneal sub-epithelial nerve density （NCND） （t=7.34, P 〈0.001）, TCND and NCND （t =4.05, P 〈0.001） were statistically significant differences. TCND （t =2.27, P =0.026）and NCND（t =2.72, P =0.008）between Grade Ⅰ and Grade Ⅱ with wear- ing CL group were also statistically significant differences. Conclusions Dry eye and contact lens wear are two important factors to cause the change of the patients＇ peripheral corneal sub-epithelial nerve density （temporal and nasal）.

关 键 词：干眼 接触镜 显微镜检查 共焦 角膜 神经密度 

分 类 号：R772.21[医药卫生—眼科]