CAJ | 학술논문

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-free Epi-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) cells/mm2;对照组基底上皮细胞数目为(3989.2±289.6)cells/mm2,二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.
목적 연구연성각막접촉경대각막상피조직적기저세포수목、상피후도、기저세포형태、증식세포핵항원(PCNA)등적영향.방법 전첨성병례대조연구.선택배대연성각막접촉경초과3년적환자33례(66안,각막접촉경조)화종미배대연성각막접촉경환자33례(66안,대조조),대소선환자,재거판준분자격광상피하각막마양술(Flap-free Epi-LASIK)수술중,용Epi-K각막상피도취하각막상피판.2조중각취30례(60안)채용초성진행리체각막상피판후도적측량화채용현미경진행기저세포계수,각취3례(6안)진행석사절편급면역조화염색,관찰각막상피판기저세포형태적변화화진행PCNA적측정.수거채용독립양본t검험진행분석.결과 각막접촉경조각막상피층후도위(55.33±4.56) μm;대조조각막상피층후도위(57.19±3.82)μm,이자지간차이유통계학의의(t=-2.422,P＜0.05).각막접촉경조기저상피세포수목감소,위(3872.6± 153.2) cells/mm2;대조조기저상피세포수목위(3989.2±289.6)cells/mm2,이자지간차이유통계학의의(t=-2.757,P＜0.01).각막접촉경조교대조조각막기저세포배렬소송,세포형태흠규정,기저막교후,상대조조.각막접촉경조각막상피기저세포가발현PCNA양성세포,이대조조무양성세포.결론 장기배대연성각막접촉경가도치각막상피손상:사각막상피층변박;단위면적내적적각막상피기저세포수량감소;각막상피적조직결구발생병이학개변,세포형태발생개변,세포지간적련접화기저막조도파배,PCNA양성세포존재.
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 comeal epithelium in the control group was 57.19±3.82 μm and the number of basal epithelial cells were 3989.2±289.6 cells/mm2.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 pathology.There are also changes in cell morphology,cell-cell junctions,destruction of the basal membrane,and the presence of PCNA positive cells.