长期配戴角膜接触镜者角膜上皮的病理改变

发布时间：2018-02-14 01:12

本文关键词： 角膜软性接触镜病理免疫组化　出处：《泰山医学院》2010年硕士论文　论文类型：学位论文

【摘要】：目的通过对比的方法,研究长期配戴角膜软性接触镜患者和从未配戴角膜软性接触镜患者的角膜上皮,观察角膜上皮组织的基底细胞数目、上皮厚度、基底细胞形态、PCNA等方面的不同变化,了解长期配戴角膜软性接触镜对角膜的影响,从而为临床提供有效的治疗手段。方法 1.选择患者：选配戴角膜接触镜超过三年的患者和从未配戴角膜接触镜患者各33例。 2.实验分组： (1)实验组：配戴软性角膜接触镜超过三年的患者33例66眼； 1)实验A组：配戴软性角膜接触镜超过三年的患者30例60眼,其中男性13例26眼,女性17例34眼,年龄18—41岁,平均27.38±5.66岁； 2)实验B组：配戴软性角膜接触镜超过三年的患者3例6眼,其中男性1例2眼,女性2例4眼； (2)对照组：从未配戴角膜接触镜患者33例66眼； 1)对照A组为从未配戴角膜接触镜患者30例60眼,其中男性15例30眼,女性15例30眼,年龄18—40岁,平均26.87±6.73岁； 2)对照B组为从未配戴角膜接触镜患者3例6眼,其中男性2例4眼,女性1例2眼。 3.取材：对所选患者,在准分子Flap-free Epi-LASIK手术中,用Epi-K角膜上皮刀取下角膜上皮瓣。 4.检测(A组患者)： (1)厚度测量：将角膜上皮瓣展开,平放在载玻片上,采用超声方法测量其厚度； (2)基底细胞计数： 1)角膜上皮瓣经过HE染色、固定、脱水、透明、封片后,在显微镜下观察其基底细胞数目的变化； 2)将新鲜角膜上皮瓣经瑞氏染色,在显微镜下观察其基底细胞数目的变化。 5.形态学观察(B组患者)： 1)取角膜上皮瓣,经过固定、脱水、透明、包埋、切片、HE染色、固定、脱水、透明、封片后在病理显微镜下观察角膜上皮瓣及其细胞形态的变化； 2)取角膜上皮瓣,常规切片,经免疫组织化学染色后,在高倍显微镜下进行增殖细胞核抗原(Proliferating Cell Nuclear Antigen简称PCNA)测定。结果 1.通过超声测量离体角膜上皮瓣的厚度,长期配戴角膜软性接触镜组角膜上皮层厚度为55.33±4.56gm；对照组角膜上皮层厚度为57.19±3.82gm,二者之间有显著差异,存在统计学意义(p0.05)。 2.通过显微镜下对离体角膜上皮瓣基底细胞的观察,发现长期配戴角膜软性接触镜组,基底上皮细胞数目减少,为3872.57±153.16个/mm2；对照组基底上皮细胞数目为3989.18±289.58个/mm2,二者之间有显著差异,存在统计学意义(p0.01)。 3.通过形态变化的对比,可以见到长期配戴软性角膜接触镜者角膜基底细胞细胞排列疏松,细胞形态欠规整,基底膜较厚,相对粗糙。 4.经过免疫组织化学标记,长期配戴软性角膜接触镜者角膜上皮基底细胞发现PCNA阳性细胞,而从未配戴软性角膜接触镜者没有发现。 5.用Epi-K取下的角膜上皮瓣基底细胞完整,界面光滑平整,无基底细胞缺失,无基质细胞存在。结论 1.长期配戴软性角膜接触镜可导致角膜上皮损伤：使角膜上皮厚度变薄；单位面积内的的角膜上皮基底细胞数量减少；可使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。 2. Epi-K角膜上皮刀可分离出完整的角膜上皮瓣,既不会有上皮细胞残留,也不会损伤前弹力层,更不会损伤基质层,可以保留光滑的平面以备准分子激光切削。证实了Epi-K角膜上皮刀在准分子激光表面切削手术中有其独特的优越性。
[Abstract]:objective
Through the method of comparison research, long-term wearing soft contact lens patients and never wearing soft contact lens corneal epithelium, observe the number of basal cells of corneal epithelial tissue epithelial thickness, basal cell morphology, different aspects of the change of PCNA, understand the long term effect of wearing soft contact lens on corneal. In order to provide effective means for clinical treatment.
Method
1. patients were selected: 33 patients who were selected to wear corneal contact lenses for more than three years and those who had never worn contact lenses.
2. group of experiments:
(1) experimental group: 66 eyes of 33 patients who wore soft contact lens for more than three years;
1) in the experimental group A, 30 patients (60 eyes) with soft contact lenses for more than three years, including 13 males and 26 eyes, 17 females and 34 eyes, aged 18 to 41 years, with an average 27.38 27.38 years old.
2) experimental group B: 3 cases of 6 eyes with a soft contact lens for more than three years, including 1 males and 2 eyes, 2 women and 4 eyes.
(2) the control group: 66 eyes of 33 patients who had never worn the contact lens of the cornea.
1) 30 cases in the control group A were never worn with corneal contact lens. Among them, there were 15 cases of male 30 eyes, 15 women in 30 eyes, 18 to 40 years old and 26.87 + 6.73 years old.
2) in group B, 6 eyes were found in 3 patients who had never worn contact lenses. Among them, there were 2 cases in males, 4 in 4, and 2 in 1 cases in women.
3.: for the selected patients, in the excimer Flap-free Epi-LASIK operation, the upper corneal flap was removed with the Epi-K corneal epithelial knife.
4. detection (group A patients):
(1) thickness measurement: the skin flap of the cornea was expanded and placed on the slide plate, and the thickness of the flap was measured by ultrasonic method.
(2) basal cell count:
1) corneal flap after HE dyeing, fixation, dehydration, transparent, mounting, observe the change of the number of basal cells under the microscope;
2) the fresh corneal epithelial flap was stained by Rayleigh, and the number of basal cells was observed under the microscope.
5. morphological observation (group B patients):
1) take corneal flap, after fixation, dehydration, transparent, embedding, slice, HE dyeing, fixation, dehydration, transparent, every changes of corneal flap's and cell morphology under the microscope in pathology;
2) take the flap above the cornea and slice it routinely. After immunohistochemical staining, the Proliferating Cell Nuclear Antigen (PCNA) was detected under the high power microscope.
Result
1., the thickness of detached upper corneal flap was measured by ultrasound. The thickness of corneal epithelial layer was 55.33 + 4.56gm in long-term contact corneal contact lens group. The thickness of corneal epithelium in control group was 57.19 + 3.82gm, and there was a significant difference between the two groups (P0.05).
2. through the microscope for observation of corneal flap from the body of basal cells, found that long-term wearing soft contact lens group, basal epithelial cells were decreased in number, 3872.57 + 153.16 /mm2; the control group the number of basal epithelial cells was 3989.18 + 289.58 /mm2, there are significant differences between the two, there were statistical significance (P0.01).
3. through morphological contrast, we can see that long term wearing soft contact lens cells have loose cells, irregular cell shape, thicker basement membrane, and relatively rough.
4. after immunohistochemical labeling, PCNA positive cells were found in corneal epithelial basal cells after long-term wearing soft contact lenses, but no soft contact lenses were found.
5. the basal cells of the skin flap from Epi-K were complete, smooth and smooth, no basal cell deletion and no stromal cells.
conclusion
1. long term wearing soft contact lens can cause corneal epithelial injury: the corneal epithelial thickness; the corneal epithelial basal cell number decreased in the area; the structure of corneal epithelium occurred pathological changes, changes in cell morphology, the connection between cells and basement membrane destruction, the presence of PCNA positive cells.
2. Epi-K Epikeratome isolated intact corneal flap, neither residual epithelial cells, it will not damage the elastic layer, but will not damage the matrix layer, can keep a smooth surface for excimer laser. Confirmed that Epi-K Epikeratome has its unique superiority in excimer laser ablation surgery.

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R772.2

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