干眼症结膜印迹细胞学研究

目的 :探讨结膜印迹细胞学检查 (CIC)在干眼诊断中的作用。方法 :对 45人 90眼正常组和 80人16 0眼实验组除采用泪液分泌实验I(S -I-T)、泪膜破裂时间 (BUT)、虎红染色 (RBS)及荧光素染色 (FLS)计分等常用眼表泪功能检查外 ,重点采用CIC ,通过观察结膜上皮细胞情况及杯状细胞数来了解正常眼、干眼的泪膜粘液层的情况。结果 :印迹细胞学分级及杯状细胞数组间均有显著的差异 ,正常组分级主要集中于 0级 ;非SS干眼组的分级主要集中于 1级和 2级 ;SS干眼组的分级主要集中于 2级及 3级。杯状细胞与虎红色计分呈负相关。结论 :结膜印迹细胞学检查通过分级、观察杯状细胞数变化 ,了解泪膜粘液层的情况可用于区分正常人与干眼症患者并可了解干眼的病程变化     

糖尿病泪液功能和眼表面变化

目的:探讨糖尿病患者泪液功能和眼表面失调及其影响因素。方法:研究60例120眼非胰岛素依赖型患者,根据病程将其分为A,B,C3个组:A组患者病程<5a,B组患者病程5～9a,C组患者病程≥10a;40例80眼无糖尿病同年龄段者设为对照组。所有研究者均观察角膜荧光素染色、泪膜破裂时间及Schirmer试验;对糖尿病组及对照组各20眼行结膜印记细胞学检查。结果:糖尿病组泪膜破裂时间较对照组短(u=13.54,P<0.01),角膜荧光素染色阳性细胞检出率高于对照组(χ2=52.21,P<0.01),泪液分泌试验较对照组少(t=2.05,P<0.05)。B,C组泪膜破裂时间较A组短,泪液分泌亦减少。结膜印记细胞学检查糖尿病组结膜上皮细胞异常较多,杯状细胞数较少。结论:糖尿病患者是干眼症的易患人群;糖尿病患者的眼表疾病以泪液的质和量的失调,鳞状上皮化生、杯状细胞减少为特征。泪膜破裂时间、Schirmer试验、角膜荧光素染色检查可作为糖尿病患者的眼科常规检查。     

结膜松弛症泪液黏蛋白及球结膜杯状细胞的研究

目的:评价结膜松弛症泪液功能及结膜杯状细胞的组织病理学及超微结构改变。方法:结膜松弛症与正常对照组各30例(60眼)进行泪膜破裂时间(tearbreakup time,BUT)SchirmerⅠ试验、泪液羊齿状试验(tear ferning test,TFT)检查。对10例松弛球结膜组织和10例对照组球结膜对应区组织,采用PAS,AB和HE染色,对照观察组织病理及超微结构改变。结果:结膜松弛症组BUT(7.72±2.90s)较对照组(14.40±3.68s)减少明显(P<0.05)。基础Schirmer试验中结膜松弛症组(13.20±4.07mm)较对照组(16.73±4.41mm)明显降低(P<0.05)。结膜松弛症组泪液中羊齿状结晶明显减少,与对照组间比较差异有显著意义(P<0.05)。结膜松弛症球结膜上皮中的杯状细胞密度为2.75±2.68/100个上皮细胞,对照组为4.64±3.25/100个上皮细胞,两组间差异无显著性(t=1.42,P=0.172)。随着结膜松弛症程度加重,球结膜杯状细胞密度降低。结膜松弛症球结膜杯状细胞组织形态和超微结构有异常。结论:结膜松弛症泪膜稳定性下降、泪液分泌减少,泪液中黏蛋白减少,结膜杯状细胞数量减少,超微结构有异常。     

口服降糖药和胰岛素对眼表治疗的影响（英文）

目的：描述和对比口服降糖药（OAD）和胰岛素治疗2型糖尿病患者眼表的效果。方法：在安卡拉卫生部培训和研究医院就诊的20例40眼口服降糖药患者,20例40眼胰岛素治疗患者,对照组的10例非糖尿病人作为研究对象。对所有患者进行常规眼科检查,Schirmer试验,泪膜破裂时间分析和结膜印迹细胞学分析.比较三组的泪液功能参数,杯状细胞密度和鳞状上皮化生等级。记录视网膜病变及眼表疾病之间的关系。结果：口服降糖药患者泪膜破裂时间值明显低于其他组（P〈0.05）。三组的杯状细胞密度和鳞状上皮化生等级相近。上皮细胞稍大,呈现更多的多边形的眼的中位数级为1级,并且嗜酸性染色胞浆和杯状细胞数量减少。视网膜病变与眼表疾病不相关。结论：口服降糖药患者的角膜前泪膜稳定性比其他组差。各组的印迹细胞学分析结果相似。     

结膜印迹细胞学检查在干眼症诊断中的应用

目的:探讨结膜印迹细胞学检查在干眼症诊断中的作用。方法:收集2008-04/2008-09眼科门诊干眼症患者36例72眼,正常人10例20眼,采用结膜印迹细胞学检查联合PAS染色,观察各组结膜上皮细胞和杯状细胞形态及数量变化情况。结果:在形态学方面,97%的正常人表现为Nelson分级中的0级,84%轻度干眼症患者表现为Nelson分级中的1级,79%中度干眼症患者符合Nelson分级中的2级,98%重度干眼症患者符合Nelson分级中的3级;在高倍镜下任意选取五个视野,统计杯状细胞的数量,轻度干眼症组(101.67±15.64),中度干眼症组(40.77±5.39)及重度干眼症组(6.36±3.61)较正常组(196.10±22.53)相比,杯状细胞数量明显减少,P<0.01,重度与轻中度干眼症组比较,前者杯状细胞数量明显少于后两者,差异有统计学意义(P<0.01)。结论:结膜印迹细胞学检查操作简单易行,结果客观精确,联合其他检查方法用于干眼症诊断,有着良好的应用前景。     

口服降糖药和胰岛素对眼表治疗的影响

目的:描述和对比口服降糖药(OAD)和胰岛素治疗2型糖尿病患者眼表的效果。方法:在安卡拉卫生部培训和研究医院就诊的20例40眼口服降糖药患者,20例40眼胰岛素治疗患者,对照组的10例非糖尿病人作为研究对象。对所有患者进行常规眼科检查,Schirmer试验,泪膜破裂时间分析和结膜印迹细胞学分析.比较三组的泪液功能参数,杯状细胞密度和鳞状上皮化生等级。记录视网膜病变及眼表疾病之间的关系。结果:口服降糖药患者泪膜破裂时间值明显低于其他组(P<0.05)。三组的杯状细胞密度和鳞状上皮化生等级相近。上皮细胞稍大,呈现更多的多边形的眼的中位数级为1级,并且嗜酸性染色胞浆和杯状细胞数量减少。视网膜病变与眼表疾病不相关。结论:口服降糖药患者的角膜前泪膜稳定性比其他组差。各组的印迹细胞学分析结果相似。     

糖尿病角结膜上皮病变的临床研究

目的 通过对2型糖尿病患者的泪膜和眼表病变进行临床检测,探讨2型糖尿病与泪膜和角结膜上皮改变的相关性.方法 对25例(50只眼)糖尿病住院患者和25例(50只眼)无糖尿病者(年龄匹配)做眼表检查,包括泪膜破裂时间(BUT),泪液分泌试验(Schirmer I),角膜荧光素染色,结膜印迹细胞学榆查,并对结果进行统计学分析.结果 尿病组98.0%的眼泪膜破裂时间小于10s,泪膜破裂时间(4.56±2.02)s低于对照组(6.76±4.11)s;66.0%的患者泪液分泌试验小于5mm,泪液分泌值(4.52±2.84)mm低于对照组为(6.28±3.65)mm;角膜上皮着色占58.0%,结膜杯状细胞密度下降,鳞状上皮化生程度加重.结论 糖尿病患者泪膜稳定性显著下降,是引起十眼症的主要原因.对糖尿病病人进行泪膜破裂时间、泪液分泌试验、角膜荧光素染色、结膜印记细胞学检查有助于早期发现糖尿病的角结膜上皮病变.     

糖尿病角膜结膜上皮病变和血清可溶性E选择素相关性研究

目的探讨糖尿病（DM）角膜结膜上皮改变的情况及其与血清可溶性E选择素之间的相关性。方法分别测定25例（50眼）2型糖尿病患者和25例（50眼）健康对照组泪膜破裂时间（BUT）、基础泪液分泌试验（SchirmerⅠ）、角膜荧光素染色（FL）、结膜印记细胞学（IC）检查,并将检测结果与年龄、DM病程、糖尿病视网膜病变（DR）、血清E-选择素等进行相关分析。结果DM组的BUT值、SchirmerⅠ值、结膜杯状细胞密度均低于对照组,角膜上皮荧光素染色着色率、结膜鳞状上皮化生级别高于对照组,差异均有统计学意义（P〈0.05）。DM组的结膜杯状细胞密度和鳞状上皮化生的级别与血清可溶性E选择素有显著相关性（P〈0.01）。结论DM患者泪膜功能和角结膜上皮均有损害,且血清E选择素水平高者,结膜杯状细胞密度下降愈明显,上皮细胞鳞状化生程度愈高。     

干眼症和前睑缘炎及季节性过敏性结膜炎中三种检测方法结果的比较

目的:比较三组临床患者和对照组患者的泪液功能测试,眼表染色以及结膜印象细胞学检测的结果。方法:这是一个单中心,前瞻性,双盲,随机对照试验。研究包括泪液分泌分数小于10mm和泪膜破裂时间(TBUT)小于10s的20例干眼症患者,有干燥和结痂睫毛的20例前睑缘炎患者,上眼睑睑板结膜乳头肥大的20例季节性过敏性结膜炎患者和20例对照组患者。比较泪液分泌的分数,泪膜破裂时间,眼表染色(牛津分级方案),杯状细胞密度(尼尔森分级方案评估所有患者的印象细胞学和化生分数)。结果:三组患者和对照组患者在泪液功能测试结果,眼表染色评分,杯状细胞密度和化生分数上有显著差异(P<0.001)。结论:结果证明这三种疾病的炎症反应造成严重眼表损害,并在局部产生炎症。这种损伤产生非常严重的影响,尤其是对结膜杯状细胞密度和化生。杯状细胞损伤程度与临床研究结果有关联。     

正常人眼及戴角膜接触镜眼的结膜表面细胞变化

我们采用结膜印迹细胞学(eonjunctival impression cytology，CIC)方法研究正常人及配戴角膜接触镜患者眼的结膜杯状细胞数量、密度，上皮细胞的形态及角化程度与其年龄间的关系。     

原发性开角型青光眼和高眼压患者及正常人群结膜印迹细胞学检查的比较

目的：比较原发性开角型青光眼和高眼压患者及拥有健康眼球表面的正常人群的泪膜功能和印象细胞学检查的数值。
　　方法：此前瞻性研究中纳入了原发性开角型青光眼患者11例11眼(平均年龄：62.7±6.1岁),高眼压患者12例12眼(平均年龄：62.8±6.4岁)及健康人12例12眼(平均年龄：62.9±6.03岁)。这些患者均是最近被诊断出患有原发性开角型青光眼及高眼压,且之前未接受过抗青光眼方面的治疗。均行结膜印迹细胞学检查、泪膜破裂时间和基础泪液分泌试验。每组印迹细胞学检查的样本根据Nelson分级法分为0~3级。应用Kruskal-Wallis检验和Dunn多重比较检验进行统计分析。
　　结果：原发性开角型青光眼患者,高眼压患者及正常人群平均基础泪液分泌值分别为10.4±1.3,10.9±1.2和11.1±1.1 mm/5min,其差距没有统计学意义(P=0.33);三组的泪膜破裂时间分别为11.2±1.1,11.3±1.1和11.8±1.2s,其差距没有统计学意义(P=0.35)。原发性开角型青光眼患者中6眼(54.5%)为0级,5眼(45.5%)为1级。高眼压患者中6眼(50%)为0级,6眼(50%)为1级,健康人中6眼(50%)为0级,6只眼(50%)为1级(P=0.97)。
　　结论：氧化应激可能会导致青光眼,眼表疾病,泪腺功能障碍及机体杯状细胞所分泌的黏液减少。原发性开角型青光眼患者,高眼压症患者及健康人群间的印象细胞学检查数值并无显著差异。     

Alterations of the tear film and ocular surface health in chronic smokers

OBJECTIVE: To investigate the effects of chronic smoking on ocular surface and tear functions. METHODS: Fifteen right eyes of 15 healthy chronic smokers (9 men, 6 women; age range: 36-47 years) who smoked 20 cigarettes per day for 20 years and 20 eyes of 20 control non-smokers (12 men, 8 women; age range: 38-43 years) were included in this prospective study. All subjects underwent measurements of breath and haemoglobin CO concentration, tear lipid layer interferometry, evaporimetry, tear film break-up time (TBUT), Schirmer's I test, corneal fluorescein staining, conjunctival impression, and brush cytology. RESULTS: The mean Hb CO level was significantly higher in smokers compared to non-smokers. TBUT was also significantly shorter in smokers. Tear lipid layer showed significant slowing in spread over the tear film with a concomitant significant increase in tear evaporation rate. Conjunctival impression cytology revealed significant loss of goblet cells and squamous metaplasia in smokers. Brush cytology showed significant conjunctival neutrophil infiltration in smoker subjects. CONCLUSION: Chronic smoking induced distinctive quantitative and qualitative disturbances on the ocular surface health.     

Impression cytology with scanning electron microscopy: a new method in the study of conjunctival microvilli

PURPOSE: Recent studies used impression cytology with scanning electron microscopy (SEM) to study the conjunctival surface of bovine eyes and normal human eyes. The purpose of this study was to evaluate the use impression cytology and SEM (ICSEM) in patients affected by tear film abnormalities. METHODS: Forty-five patients were divided into three groups according to mild, moderate or severe subjective sensation of dry eye. Fifteen asymptomatic subjects served as control group. In all patients the tear film was evaluated with break-up time (BUT), Schirmer's, and Ferning test, whereas conjunctival epithelium was evaluated with impression cytology and optic microscopy (ICOM), and ICSEM. The Spearman rank correlation test was used to compare the outcome of these examinations with the subjective sensation of dry eye in each group, and to identify correlations among the five tests. RESULTS: ICSEM findings highly correlated with subjective dry eye sensation (Spearman correlation coefficient, 796; P<0.01). ICSEM revealed incipient epithelial damage (reduction or absence of microvilli) before the appearance of alterations of nucleus and cytoplasm of epithelial cells revealed by optic microscopy. The number of microvilli was correlated with the degree of tear film abnormalities and subjective sensation of dry eye (Spearman correlation coefficient, 796; P<0.01). CONCLUSION: ICSEM was very effective in detecting the reduction in the number of microvilli. Therefore, it could represent an effective method to detect alterations in the conjunctival epithelium resulting from tear film damage even before the epithelial damage occurs and is detected by optic microscopy.     

Relationship between goblet cell density and tear function tests

AIM: The objective of this study was to find a relationship between goblet cell density (GCD) and other diagnostic tests of dry eye in a group of normal healthy Chinese subjects. The capability of using GCD as a tear function test was assessed. METHOD: A total of 42 optometry students with no contact lens wear history were recruited. Subjects were required to fill in a dry eye questionnaire. The non-invasive tear break-up time (NITBUT) of each subject was measured, followed by phenol red thread test (PRTT) and tear break-up time (TBUT) tests. Conjunctival epithelial cells from the inferior nasal bulbar conjunctiva were harvested by the impression cytology technique. The specimens collected were labelled and stained with PAS (Periodic Acid Schiff)-haematoxylin. The goblet cells and the conjunctival epithelial cells were counted under a light microscope of 100x magnification. Spearman's rho (rho) correlation test was used to analyse the relationship between GCD and the other tear function tests. RESULTS: With a probability level of 0.0051 (corrected for a cumulative familywise error rate of p = 0.05), GCD was found to have no correlation with NITBUT (rho = -0.193, p = 0.222), McMonnies Dry Eye Scores (MCDES) (rho = -0.052, p = 0.742), PRTT (rho = - 0.188, p = 0.234) and TBUT (rho = 0.246, p = 0.117). CONCLUSION: There was no correlation between GCD and MCDES, NITBUT, PRTT and TBUT. The GCD alone is not a useful diagnostic test for tear film instability in normal eyes although it is a good indicator in the diagnosis of ocular surface diseases.     

Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome

BACKGROUND: In this study, ocular surface changes and tear film functions in patients with pseudoexfoliative glaucoma (PEXG) and pseudoexfoliation (PEX) syndrome were evaluated. METHODS: This study is a randomized, double-blind and prospective study. Conjunctival impression cytology, tear film break-up time (TFBUT) test and basal Schirmer test (BST) were performed on 45 eyes of 45 subjects with PEXG (group I), 48 eyes of 48 subjects with PEX syndrome (group 2) and 50 eyes of 50 normal subjects (group 3). Impression cytology was graded 0-III based on the shape, eosinophilic-staining cytoplasm and nucleocytoplasmic ratio of the epithelial cells, and the shape, quantity and Periodic Acid Schiff-positive cytoplasm of the goblet cells. RESULTS: Impression cytology grading scores were 6.7% grade 0, 15.6% grade I, 37.7% grade II and 40% grade III in group 1, 6.3%, 18.7%, 43.8% and 31.2% in group 2 and 38%, 36.0%, 20% and 6% in group 3, respectively. The scores in groups 1 and 2 were significantly higher than in group 3 (P = 0.001, chi(2) = 39.84). The mean values of TFBUT of groups 1, 2 and 3 were 5.91 +/- 3.27, 7.39 +/- 4.82, 10.96 +/- 3.81 s and the mean values of BST were 7.82 +/- 3.56, 9.04 +/- 4.60 and 12.50 +/- 5.25 mm/5 min, respectively. The values of TFBUT and BST were lower in groups 1 and 2 than in group 3 (P = 0.001). CONCLUSION: The conjunctival changes in PEX and PEXG patients recorded in this study may explain the existence of tear film abnormalities in these patients. It has been shown that PEXG and PEX syndrome cause conjunctival surface changes and reduction of tear film functions.     

Diagnostic tests for dry eye disease in normals and dry eye patients with and without Sj?gren's syndrome.

In order to compare the diagnostic tests for dry eye disease and the results of conjunctival impression cytology, we examined three groups of eyes: 146 eyes of normal controls, 108 eyes of keratoconjunctivitis sicca (KCS) patients without Sj?gren's syndrome (SS) and 102 eyes of patients with SS. The clinical tests (break-up time, Schirmer test, Rose Bengal staining) and conjunctival impression cytology specimens from the superior part of the bulbar conjunctiva were evaluated from all the eyes. Our results showed that the patients with KCS without SS have abnormal lacrimal tests (p < 0.001) without changes in impression cytology [nucleo/cytoplasmic ratio (N/C), p > 0.1]. The patients with KCS and SS have also abnormal lacrimal tests (p < 0.01), and their epithelial cells presented squamous metaplasia (N/C, p < 0.001). The goblet cell number remained unchanged in the three groups (p > 0.1).     

Flow cytometric analysis of conjunctival epithelium in ocular rosacea and keratoconjunctivitis sicca

PURPOSE: To investigate by flow cytometry and impression cytology (IC) specimens the inflammatory status of the conjunctival epithelium and goblet cell density in two series of patients with rosacea and dry eye syndrome compared with a population of healthy subjects. DESIGN: Nonrandomized, prospective, comparative case series. PARTICIPANTS: Twenty-six eyes of 13 patients with rosacea, 26 eyes of 13 patients with dry eye syndrome, and 24 eyes of 12 control subjects were included in this study. METHODS: IC specimens were collected after clinical examination of the ocular surface and analyzed by flow cytometry, using antibodies directed to human lymphocyte antigen-DR (HLA-DR), intercellular adhesion molecule-1 (ICAM-1) (CD 54), and the peptidic core of the conjunctival mucin (M1/MUC5AC). The percentage of positive cells was calculated and levels of fluorescence expression quantified and compared with those obtained in a series of 12 healthy subjects. MAIN OUTCOME MEASURES: Tear break-up time (TBUT), Schirmer test, fluorescein and lissamin green stainings, and IC were realized in this study. RESULTS: A significant increase of HLA-DR and ICAM-1 expressions by epithelial cells was consistently found in the two pathologic groups compared with levels calculated in normal eyes. The two markers were well correlated with each other and inversely with TBUT and Schirmer test. The percentage of goblet cells was significantly decreased in rosacea patients and in dry eye patients compared with the normal group with a significant negative correlation with both HLA DR and ICAM-1 markers. CONCLUSIONS: Ocular rosacea and keratoconjunctivitis sicca were associated with severe ocular surface changes, such as an overexpression of inflammatory markers and a significant decrease in the number of goblet cells.     

Adverse effects of topical antiglaucoma drugs on the ocular surface

Purpose : This study was designed to determine the effect of long‐term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer’s and tear break‐up time tests using conjunctival impression cytology. Methods : The ocular surfaces of 30 control subjects (group 1), 24 primary open‐angle glaucoma patients treated with 0.5% betaxolol hydrochloride (group 2), 27 primary open‐angle glaucoma patients treated with 0.5% timolol maleate (group 3) and 26 primary open‐angle glaucoma patients treated with 0.5% betaxolol and 1% dipivefrin hydrochloride (group 4) were evaluated. Basal Schirmer’s and tear break‐up time tests were measured and ocular surface changes were determined by impression cytology. Impression cytology specimens of each group were graded and scored in the range 0–3 according to Nelson’s method. Results : Patients in groups 2, 3 and 4 showed statistically significant fewer normal basal Schirmer’s tests (wettability) and tear break‐up time tests (P < 0.01). Also, the conjunctival impression cytology scores were significantly higher in groups 2, 3 and 4 than in group 1 (P < 0.01). Conclusions : The conclusion was that it is possible that conjunctival surface and tear film function change after the long‐term use of antiglaucoma medication.     

长期使用青光眼药物对眼表的影响

目的 探讨长期使用青光眼药物对患者眼表的影响.方法 收集局部使用青光眼药物3个月以上的患者65例108只眼,分为单种药物使用组(A组)和多种药物使用组(B组);另收集正常对照组(c组)25例25只眼.对所有观察对象进行泪膜破裂时间测定(BUT)、基础泪液分泌试验(ST)、角膜上皮荧光素染色、结膜上皮虎红染色以及结膜印迹细胞(IC)检查.结果 正常对照组BUT(12.25±5.40)s,ST(11.65±4.66)mm,A组BUT(6.97±4.87)8 9ST(7.19±5.36)mm,明显低于正常对照组(BUT P=0.000;STP=0.001). B组BUT(4.81±2.45)s,显著短于正常对照组(P=0.000)和A组(P=0.008);ST(5.20±2.97)mm,显著少于正常对照组(P=0.000)和A组(P=0.026).A组和B组的角膜荧光素染色评分和结膜虎红染色评分显著高于正常对照组.与正常对照组相比,A组和B组IC评分2-3级所占比例明显增高,结膜上皮表现出鳞状上皮化趋势.结论 长期使用青光眼药物会导致患者泪膜稳定性下降、泪液分泌减少,角膜上皮荧光素染色增多,结膜上皮杯状细胞减少、上皮细胞呈鳞状上皮化等泪膜、角膜和结膜的损伤.