CAJ | 학술논문

目的研究睑内翻倒睫所致的机械性损伤在矫正手术前后对角、结膜上皮细胞及泪膜稳定性的影响,并对术后的相应改善情况进行分析.方法临床病例系列研究.对2009年1～12月在吉林大学第二临床学院眼科就诊的60例(106只眼)睑内翻倒睫患者,按眼数分三组:先天性睑内翻组(n=41),老年性睑内翻组(n=45),瘢痕性睑内翻组(n=20),所有患者术前、术后1周及术后1个月分别行泪液分泌试验(schirmer test I,STI)、泪膜破裂时间(tear break-up time,BUT)、角膜荧光素染色(cornea fluorescein staining,CFS)及结膜印迹细胞学(conjunctival impression cytology,CIC)检查(根据Nelson分级),分别对比手术前、后的泪膜功能状态,杯状细胞密度及结膜上皮细胞鳞状化生程度.结果 (1)与术前相比较,三组睑内翻倒睫患者行矫正手术后1周及1个月的泪液分泌量无明显变化(P＞0.05).(2)三组睑内翻倒睫患者行矫正手术后与术前比较BUT明显延长,差异均有统计学意义(P＜0.05).(3)通过三组患者手术前、后角膜荧光染色比较可以看出,各组睑内翻倒睫患者行矫正手术后,患者角膜程度不同恢复光滑透明,角膜荧光素着色减轻甚至消失,角膜荧光素染色评分的均值均下降,差异均有统计学意义(P＜0.05).(4)先天性和老年性睑内翻患者术后的鳞状化生都有不同程度的降低,杯状细胞密度亦明显增加,差异有统计学意义(P＜0.05).瘢痕性睑内翻患者术后鳞状化生程度有所降低(P＜0.05),但杯状细胞密度无明显增加(P＞0.05).结论睑内翻倒睫所致的眼表机械性损伤可导致结膜上皮细胞鳞状化生,杯状细胞数量减少,角膜上皮完整性破坏及泪膜稳定性下降;及时且有效地睑内翻倒睫矫正术可明显改善上述情况.
목적 연구검내번도첩소치적궤계성손상재교정수술전후대각、결막상피세포급루막은정성적영향,병대술후적상응개선정황진행분석.방법 림상병례계렬연구.대2009년1～12월재길림대학제이림상학원안과취진적60례(106지안)검내번도첩환자,안안수분삼조:선천성검내번조(n=41),노년성검내번조(n=45),반흔성검내번조(n=20),소유환자술전、술후1주급술후1개월분별행루액분비시험(schirmer test I,STI)、루막파렬시간(tear break-up time,BUT)、각막형광소염색(cornea fluorescein staining,CFS)급결막인적세포학(conjunctival impression cytology,CIC)검사(근거Nelson분급),분별대비수술전、후적루막공능상태,배상세포밀도급결막상피세포린상화생정도.결과 (1)여술전상비교,삼조검내번도첩환자행교정수술후1주급1개월적루액분비량무명현변화(P＞0.05).(2)삼조검내번도첩환자행교정수술후여술전비교BUT명현연장,차이균유통계학의의(P＜0.05).(3)통과삼조환자수술전、후각막형광염색비교가이간출,각조검내번도첩환자행교정수술후,환자각막정도불동회복광활투명,각막형광소착색감경심지소실,각막형광소염색평분적균치균하강,차이균유통계학의의(P＜0.05).(4)선천성화노년성검내번환자술후적린상화생도유불동정도적강저,배상세포밀도역명현증가,차이유통계학의의(P＜0.05).반흔성검내번환자술후린상화생정도유소강저(P＜0.05),단배상세포밀도무명현증가(P＞0.05).결론 검내번도첩소치적안표궤계성손상가도치결막상피세포린상화생,배상세포수량감소,각막상피완정성파배급루막은정성하강;급시차유효지검내번도첩교정술가명현개선상술정황.
Objective To investigate the effects of the mechanical injury of ocular surface by trichiasis to tear film and epithelial cell stability between pre-operation and post-operation,and the situation of improvement of ocular microenvironment postoperatively.Methods In this study,60 inpatients (106 eyes) due to trichiasis were randomly selected.According to the pathogenesis,all patients were divided into three groups:congenital entropion group (n =41),senile entropion group (n =45) and cicatricial entropion group (n =20).All enrolled patients in this study were examined by Schirmer's I test (STI),tear film break up time (BUT),cornea fluorescein staining (CFS) and Conjunctival impression cytology (CIC) before surgery,one week and one month after surgery respectively.The results such as functional status of the tear film,goblet cell density and the degree of squamous metaplasia of conjunctival epithelial cells were compared between pre-operation with post-operation,and the degree of improvement of ocular surface microenvironment after operation were evaluated.Results Compared to the results of pre-operation,there was no significant changes in tear secretion in three groups at 1 week and 1 month after operation (P ＞0.05).The BUT of post-operation in three groups was much longer than the pre-operation's,there was statistical significance (P ＜0.05).Compared with the results of pre-operation,the CFS was reduced or even disappeared in all cases after surgery,the score of CFS was decreased,there was statistically significant (P ＜0.05).Moreover,the smoothly and transparently corneas were reappeared in most case after surgery.The squamous metaplasia was decreased in different degree in the group of congenital and senile entropion after surgery.And the goblet cell density was increased at the same time.There was statistical significance (P ＜0.05).The squamous metaplasia was decreased in the group of cicatricial entropion after surgery (P ＜0.05),but there was no evident increase in goblet cell density (P ＞0.05).Conclusions The persistent mechanical trauma by cilia in patients with entropion or trichiasis can induce the increase of conjunctival squamous metaplasia,the decrease of goblet cells density,the damage of the integrity of corneal epithelium and the stability of tear film.However,these changes can be reversed by an appropriately and timely surgical treatment.