配戴透气性硬性角膜接触镜对青少年角膜组织形态学的影响

发布时间：2018-06-28 04:40

本文选题：显微镜检查 + 共焦　；参考：《青岛大学》2011年硕士论文

【摘要】：目的应用共焦显微镜观查近视青少年配戴透气性硬性角膜接触镜(Rid gas permeable contact lens,简称RGPCL)在不同时期角膜组织的变化,客观评价配戴透气性硬性角膜接触镜对青少年角膜组织近期的影响。方法选取2009年3月至2010年7月在沧州眼科医院进行RGPCL矫正治疗的青少年近视患者45例,所有患者均为双眼戴镜。根据屈光度不同分为两个观察组,Ⅰ组27例为夜戴组,近视度≤-5.00D且散光度-1.25D者；Ⅱ组18例为日戴组,近视度-5.00D且散光度≤-1.75D者。在两组患者戴镜6个月内定期行眼部检查及共焦显微镜检查。戴镜前为对照组,戴镜后为实验组,观察患者裸眼视力、矫正视力及屈光度的变化,并使用共焦显微镜对患者角膜进行检查,取中央角膜和上方角巩膜缘内2mm处角膜为检查点,取上皮波、神经纤维波、基质波、内皮波完整的Z-SCAN图像进行分析,角膜各层的扫描图像通过液晶显示器同步显示记录,并利用内置计数软件计算角膜各层细胞密度和角膜各层厚度的变化。结果 (1)裸眼视力及屈光度：Ⅰ组54眼戴镜后6月与戴镜前相比,裸眼视力明显提高(t=30.604；p=0.000),屈光度明显下降(t=18.324；p=0.000),差异有统计学意义；Ⅱ组36眼戴镜后6月与戴镜前相比,裸眼视力无明显提高(t=1.414；p=0.162),屈光度无明显下降(t=0.476；p=0.636),差异无统计学意义。 (2)角膜各层细胞密度： ①上皮细胞层：Ⅰ组患者中央角膜上皮细胞密度戴镜后与戴镜前相比,差异有统计学意义(F=3.597,p=0.001),戴镜后2月至6月与戴镜前相比明显减少(q=4.189,4.473,4.642；p=0.042,0.031,0.029)。Ⅰ组患者周边角膜上皮细胞密度戴镜后与戴镜前相比,差异有统计学意义(F=3.803,p=0.001),戴镜后2月至6月与戴镜前相比明显增加(q=4.229,4.505,4.844；p=0.039,0.030,0.019)。Ⅱ组患者角膜中央和周边上皮细胞密度戴镜后与戴镜前相比,差异无统计学意义(F=0.736,0.464；p=0.642,0.860)。Ⅰ组患者戴镜后中央及周边角膜上皮内朗格罕细胞密度与戴镜前相比,差异有统计学意义(F=3.733,3.486；p=0.001,0.001),戴镜后3月至6月与戴镜前相比明显增加(中央q=4.410,4.991；p=0.036,0.013；周边q=4.439,4.951；p=0.034,0.015)。Ⅱ组患者戴镜后中央及周边角膜上皮内朗格罕细胞密度与戴镜前相比,差异无统计学意义(F=1.667,1.381；p=0.117,0.213) ②浅基质层：Ⅰ组患者角膜中央和周边浅基质层细胞密度戴镜后与戴镜前相比,差异有统计学意义(F=3.230,3.409；p=0.002,0.002),戴镜后2月至6月与戴镜前相比明显减少(中央q=4.203,4.373,4.876；p=0.041、0.039、0.017；周边q=4.284,4.682,4.981；p=0.035,0.021,0.014)。Ⅱ组患者角膜中央和周边浅基质层细胞密度戴镜后与戴镜前相比,差异无统计学意义(F=1.083,0.632；p=0.374,0.729) ③深基质层：Ⅰ组患者角膜中央和周边深基质层细胞密度戴镜后与戴镜前相比,差异无统计学意义(F=1.176,1.867；p=0.316,0.074)。Ⅱ组患者角膜中央和周边深基质层细胞密度戴镜后与戴镜前相比,差异亦无统计学意义(F=0.746,0.674；p=0.633,0.694)。 ④内皮细胞层：Ⅰ组患者角膜中央和周边内皮细胞密度戴镜后与戴镜前相比,差异有统计学意义(F=3.351,3.080；p=0.002,0.004)。中央角膜平均细胞面积、六角形细胞百分率戴镜后与戴镜前相比,差异有统计学意义(F=3.577,3.911；p=0.001,0.001),尤其戴镜后2月至6月与戴镜前相比,平均细胞面积增大(q=4.302,4.467,4.727；p=0.034,0.032,0.024),六角形细胞百分率下降(q=4.267,4.664,5.359；p=0.036,0.021,0.006)。Ⅱ组患者角膜中央和周边内皮细胞密度戴镜后与戴镜前相比,差异无统计学意义(F=0.915,0.658；p=0.495,0.708)。中央角膜平均细胞面积、六角形细胞百分率戴镜后与戴镜前相比,差异亦无统计学意义(F=0.710,0.793；p=0.663,0.594)。 (3)角膜厚度变化 ①上皮厚度 Ⅰ组患者中央角膜上皮层厚度戴镜后与戴镜前相比,差异有统计学意义(F=3.339,p=0.002),尤其戴镜后3月至6月与戴镜前相比明显变薄(q=4.420,4.577；p=0.035,0.033)。Ⅰ组患者周边角膜上皮层厚度戴镜后与戴镜前相比,差异无统计学意义(F=1.096,p=0.365)。Ⅱ组患者中央及周边角膜上皮层厚度戴镜后与戴镜前相比,差异无统计学意义(F=1.024,0.727；p=0.414,0.649)。 ②基质厚度 Ⅰ组患者中央及周边角膜基质层厚度戴镜后与戴镜前相比差异无统计学意义(F=0.929,0.729；p=0.484,0.648)。Ⅱ组患者中央及周边角膜基质层厚度戴镜后与戴镜前相比差异亦无统计学意义(F=0.859,0.461；p=0.540,0.862)。 ③全层厚度 Ⅰ组患者中央及周边角膜全层厚度戴镜后与戴镜前相比差异无统计学意义(F=1.359,0.408；p=0.221,0.897)。Ⅱ组患者中央及周边角膜全层厚度戴镜后与戴镜前相比差异亦无统计学意义(F=1.066,0.577；p=0.386,0.775)。结论 1.近视度≤-5.00D且散光度-1.25D)的青少年近视患者夜戴RGPCL近期能提高裸眼视力,降低屈光度,但会对角膜形态学造成明显影响。 2.近视度-5.00D且散光度≤-1.75D的青少年近视患者日戴RGPCL近期不能提高裸眼视力及降低屈光度,不会对角膜形态学造成明显影响。 3.应用共焦显微镜检查可评估透气性硬性角膜接触镜对角膜组织的形态学影响。
[Abstract]:Objective to investigate the changes in corneal tissue of Rid gas permeable contact lens (RGPCL) in different periods by confocal microscopy (confocal microscopy), and objectively evaluate the effect of wearing breathable hard corneal contact lens on the corneal tissue in the near future.
Methods 45 juvenile myopia patients were selected from March 2009 to July 2010 at Cangzhou ophthalmology hospital for RGPCL correction. All the patients were binocular wearing glasses. According to the diopter, two observation groups were divided, 27 cases in group I were night wear group, myopia was less than -5.00D and astigmatism was -1.25D, and 18 cases in group II were daily wear group, myopia degree -5.00D and astigmatism The eye examination and confocal microscopy were performed on two groups of patients within 6 months of wearing glasses. Before wearing the mirror, the control group was used as the control group and the experimental group after wearing the mirror. The visual acuity, the corrected visual acuity and the diopter of the patients were observed. The cornea was examined by confocal microscope, and the cornea of the cornea and the cornea of the upper corner of the upper cornea were taken at the cornea of the central cornea and the cornea of the upper cornea of the upper cornea in the 2mm. For the checkpoint, a complete Z-SCAN image of skin wave, nerve fiber wave, matrix wave and endothelial wave was analyzed. The scanning images of each layer of the cornea were recorded synchronously by liquid crystal display, and the changes in corneal layer density and the thickness of corneal layers were calculated by using the built-in counting software.
Result
(1) the visual acuity and diopter of the naked eye: in group I, the visual acuity of the naked eye was significantly improved (t=30.604; p=0.000) and the diopter decreased significantly (t=18.324; p=0.000) in June after wearing the mirror (t=18.324; p=0.000). In group II, there was no significant improvement in the visual acuity of the naked eyes (t=1.414; p=0.162) and the diopter of the 36 eyes in June. The difference was not statistically significant (t=0.476; p=0.636).
(2) the density of the cells in each layer of the cornea:
(1) epithelial cell layer: the density of central corneal epithelial cells in group I was statistically significant (F=3.597, p=0.001) compared with that before wearing mirror (q=4.189,4.473,4.642; p=0.042,0.031,0.029). In group I, the density of corneal epithelial cells in group I was compared with that before wearing glasses. The difference was statistically significant (F=3.803, p=0.001). The difference between February and June was significantly increased (q=4.229,4.505,4.844; p=0.039,0.030,0.019). In group II, there was no significant difference between the central and peripheral epithelial cells of the group II (F=0.736,0.464; p=0.642,0.860) after wearing the lens (F=0.736,0.464; p=0.642,0.860). The density of Langerhans cells in the peripheral corneal epithelium was statistically significant (F=3.733,3.486; p=0.001,0.001) compared with that before wearing glasses (F=3.733,3.486; p=0.001,0.001), which was significantly increased from March to June before wearing glasses (central q=4.410,4.991; p=0.036,0.013; peripheral q=4.439,4.951; p=0.034,0.015). Group II patients wore the central and peripheral corneal epithelium after wearing glasses. There was no significant difference in the density of Langerhans between before and after wearing (F=1.667,1.381; p=0.117,0.213).
2. Superficial stroma layer: in group I, the cell density of the central and peripheral superficial layers of the cornea was statistically significant (F=3.230,3.409; p=0.002,0.002) compared with that before wearing glasses (F=3.230,3.409; p=0.002,0.002), and compared with that before wearing glasses from February to June (central q=4.203,4.373,4.876; p= 0.041,0.039,0.017; peripheral q=4.284,4.682,4.981; p=0.035,0.0). 21,0.014). There was no significant difference in the density of central and peripheral superficial stromal cells between group II and that before wearing the lens (F=1.083,0.632; p=0.374,0.729).
(3) deep stroma layer: in group I, there was no significant difference in the density of the central and peripheral layers of the cornea after wearing mirror (F=1.176,1.867; p=0.316,0.074). In group II, there was no significant difference between the central and peripheral layers of the cornea after wearing the lens (F=0.746,0.674; p=0.633,0.6). 94).
(4) endothelial cell layer: the density of central and peripheral endothelial cells in group I was significantly different from that before wearing glasses (F=3.351,3.080; p=0.002,0.004). The average cell area of the central cornea and the percentage of hexagonal cells were statistically significant (F=3.577,3.911; p=0.001,0.001), especially after wearing mirror (F=3.577,3.911; p=0.001,0.001). The average cell area increased (q=4.302,4.467,4.727; p=0.034,0.032,0.024), and the percentage of hexagonal cells decreased (q=4.267,4.664,5.359; p=0.036,0.021,0.006) from February to June before wearing glasses (q=4.267,4.664,5.359; p=0.036,0.021,0.006). 58; p=0.495,0.708). The average cell area of the central cornea and the percentage of hexagonal cells were not statistically significant (F=0.710,0.793; p=0.663,0.594) compared with that before wearing glasses.
(3) changes in corneal thickness
Epithelial thickness
The thickness of central corneal epithelium in group I was significantly different from that before wearing mirror (F=3.339, p=0.002), especially in March to June after wearing mirror (q=4.420,4.577; p=0.035,0.033). The thickness of peripheral corneal epithelium in group I was not statistically significant (F=1.096, p=). 0.365) there was no significant difference in the thickness of corneal epithelium between central and peripheral groups after wearing glasses compared with that before wearing glasses (F=1.024,0.727; p=0.414,0.649).
Thickness of matrix
There was no significant difference in the thickness of the central and peripheral corneal stroma in group I after wearing mirror (F=0.929,0.729; p=0.484,0.648). There was no significant difference in the thickness of the central and peripheral corneal stroma in group II after wearing the mirror (F=0.859,0.461; p=0.540,0.862).
Full thickness
There was no significant difference in the total thickness of the central and peripheral cornea of group I after wearing mirror (F=1.359,0.408; p=0.221,0.897). There was no significant difference between the central and peripheral corneal thickness of the group II patients and before wearing the mirror (F=1.066,0.577; p= 0.386,0.775).
conclusion
The night wearing RGPCL of 1. myopia patients with myopia of less than -5.00D and astigmatism -1.25D can improve the visual acuity of the naked eye and reduce the diopter, but it will have a significant influence on the corneal morphology.
2. teenager myopia patients with myopia of -5.00D and astigmatism less than -1.75D can not improve the visual acuity and diopter of the naked eye in the near future, and do not have a significant influence on the corneal morphology.
3. confocal microscopy can be used to evaluate the morphological effect of gas permeable rigid contact lens on corneal tissue.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R778.11

【参考文献】