长期配戴软性角膜接触镜者角膜上皮的病理改变  

Pathological changes to the corneal epithelium from long-term contact lens wear

作　　者：郑玉胜[1] 庄宪丽[1] 杨延振[1] 张秋秋[1] 李路路[1] 

机构地区：[1]滕州市中心人民医院眼科,枣庄277500

出　　处：《中华眼视光学与视觉科学杂志》2013年第11期647-650,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的研究软性角膜接触镜对角膜上皮组织的基底细胞数目、上皮厚度、基底细胞形态、增殖细胞核抗原（PCNA）等的影响。方法前瞻性病例对照研究。选择配戴软性角膜接触镜超过3年的患者33例（66眼，角膜接触镜组）和从未配戴软性角膜接触镜患者33例（66眼，对照组），对所选患者，在去瓣准分子激光上皮下角膜磨镶术（Flap—freeEpi．LASIK）手术中，用Epi-K角膜上皮刀取下角膜上皮瓣。2组中各取30例（60眼）采用超声进行离体角膜上皮瓣厚度的测量和采用显微镜进行基底细胞计数，各取3例（6眼）进行石蜡切片及免疫组化染色，观察角膜上皮瓣基底细胞形态的变化和进行PCNA的测定。数据采用独立样本t检验进行分析。结果角膜接触镜组角膜上皮层厚度为（55．33±4．56）μm；对照组角膜上皮层厚度为（57．19±3．82）μm，二者之间差异有统计学意义（t=-2．422，P〈0．05）。角膜接触镜组基底上皮细胞数目减少，为（3872．6±153．2）eells／mm^2；对照组基底上皮细胞数目为（3989．2±289．6）cells／mm^2，二者之间差异有统计学意义（t=-2．757，P〈0．01）。角膜接触镜组较对照组角膜基底细胞排列疏松，细胞形态欠规整，基底膜较厚，相对粗糙。角膜接触镜组角膜上皮基底细胞可发现PCNA阳性细胞，而对照组无阳性细胞。结论长期配戴软性角膜接触镜可导致角膜上皮损伤：使角膜上皮层变薄；单位面积内的的角膜上皮基底细胞数量减少；角膜上皮的组织结构发生病理学改变，细胞形态发生改变。细胞之间的连接和基底膜遭到破坏，PCNA阳性细胞存在。Objective To explore the effect of long-term soft contact lens wear on a unit area of corneal epithelium cell tissue, epithelial thickness, cell morphology and proliferating cell nuclear antigen （PCNA）; to inform about the effects of contact lenses on the cornea in clinical applications. Methods This was an prospective case control study. Group A consisted of long-term （≥3 years） soft contact lens wearers （66 eyes of 33 patients） and control group B consisted of non-soft contact lens wearers （66 eyes of 33 patients）. The selected patients had undergone an excimer flap-free Epi-LASIK operation, and the corneal flap was removed with an Epi-K corneal epithelial knife. Ultrasound and microscopy were used for measurement of the corneal flap thickness and the basal cell count. Paraffin section and immunohistochemistry were used to study the morphological changes of the corneal flap, basal cells and the proliferating cell nuclear antigen. Data were analyzed using an independent t test. Results After more than 3 years of soft contact lens wear, the thickness of the corneal epithelium was 55.33±4.56 μm and the number of basal epithelial cells were 3872.6±153.2 cells/mm2. The thickness of the corneal epithelium in the control group was 57.19±3.82 μm and the number of basal epithelial cells were 3989.2±289.6 cells/ram2. There was a statistically significant difference between the experimental and control groups （t=-2.422, -2.757, P〈0.05）. In the experimental group, corneal basal cells were arranged more loosely, the cells had less structured forms, and the basal membrane was thicker and rougher compared to the control group. PCNA positive cells could be found in corneal epithelial basal cells in the experimental group but not in the control group. Conclusion Long-term wear of soft contact lenses can lead to corneal epithelium injury： the corneal epithelium thickness decrease, corneal epithelial basal cells decrease in number, the structure of the corneal epithelium developes a less organized

关 键 词：角膜 接触镜 亲水性 病理 免疫组织化学 

分 类 号：R778[医药卫生—眼科]