眼表机械性损伤与泪膜及上皮细胞稳定性关系分析

发布时间：2018-04-11 04:21

本文选题：倒睫 + 泪膜　；参考：《吉林大学》2010年硕士论文

【摘要】： 目的：研究睑内翻倒睫所致的机械性损伤对角、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60例(106眼)睑内翻倒睫患者分三组：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)及结膜印记细胞学(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(P0.05)。(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,差异均有显著性统计学意义(P＜0.05)。以术后1周及1个月的实验结果观察,相对于瘢痕性睑内翻组的泪膜破裂时间(6.02±3.43s；6.34±6.86s)来说,老年性睑内翻组(8.95±3.75s：9.43±2.67s)及先天性睑内翻组(9.20±7.35s：10.01±3.32s)较长。(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,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,绝大部分患者角膜恢复光滑透明,差异均有显著性统计学意义(P0.05)。(4)先天性和老年性睑内翻患者术后的鳞状化生程度都有不同程度的降低,杯状细胞密度亦明显增加,有显著性意义(P0.05)。瘢痕性睑内翻患者术后鳞状化生程度有所降低(P0.05)，，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,杯状细胞数量减少及泪膜稳定性下降；及时且有效的睑内翻倒睫矫正术可明显改善上述情况；相对于瘢痕性睑内翻来说,先天性睑内翻及老年性睑内翻矫正术后眼表功能恢复情况更好。
[Abstract]:Objective:To study the effects of mechanical injury induced by entropion on diagonal, conjunctival epithelial cells and lacrimal membrane stability, and to analyze the corresponding improvement after operation.Methods:60 patients with entropion and trichiasis were divided into three groups: congenital entropion group (n = 41), senile entropion group (n = 45) and scar entropion group (n = 20).Tear secretion tests were performed 1 week after operation and 1 month after operation respectively. Tear secretion tests were performed (according to Nelson grade, respectively). Tear break-up time, Butt time, fluorescein staining of cornea and conjunctival impression cytology (CICs) were performed respectively.The functional state of tear film before and after surgery,Goblet cell density and squamous metaplasia of conjunctival epithelial cells.Results:(1) there was no significant change in the amount of tear secretion in the three groups of patients with entropion and trichiasis one week and one month after orthodontic surgery. The BUT was significantly prolonged in the three groups after orthopedic surgery.The difference was significant (P < 0.05).As can be seen from the comparison of corneal fluorescence staining after corrective surgery, corneal fluorescein staining decreased or even disappeared, corneal fluorescein staining scores decreased, and most of the patients' corneas returned to smooth and transparent cornea.The difference was statistically significant (P 0.05). The degree of squamous metaplasia and goblet cell density in congenital and senile patients with entropion were decreased in different degrees, and the density of goblet cells was also significantly increased (P 0.05).The degree of squamous metaplasia decreased in patients with cicatricial entropion, but the density of goblet cells did not increase significantly (P > 0.05).Conclusion:Mechanical injury of eyelid surface caused by entropion could result in squamous metaplasia of conjunctival epithelial cells, decrease of goblet cells and decrease of tear film stability.Compared with cicatricial entropion, the recovery of ocular surface function was better after congenital entropion and senile entropion correction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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