长期配戴软性角膜接触镜者角结膜上皮的变化

目的:探讨软性角膜接触镜(soft contact lens,SCL)长期配戴者角结膜上皮的变化。方法:正常对照组35例70眼,病例组99例198眼均采用角膜荧光素染色(fluorescein vital staining,FLS)、结膜印迹细胞学检查(conjunctival impression cytology,CIC)等检查方法。依据SCL戴镜时间将SCL戴镜者区分为<5a组,5~10a组和>10a组,共3组。比较分析各组间的角膜荧光素染色、杯状细胞密度和结膜上皮鳞状化分级的差异。结果:SCL戴镜各组FLS记分、杯状细胞密度与结膜上皮鳞状化分级与正常对照组间差异有统计学意义(P<0.01);<5a组与5~10a组间,及<5a组与>10a组之间杯状细胞密度与结膜上皮鳞状化分级的差异有统计学意义(P<0.01);但5~10a组与>10a组之间杯状细胞密度与结膜上皮鳞状化分级的差异无统计学意义。结膜上皮鳞状化分级与FLS呈正相关(r=0.589,P<0.01);杯状细胞密度与FLS负相关(r=-0.351,P<0.01)。结论:长期配戴SCL会引起角膜上皮损伤和结膜上皮印迹细胞学改变,且戴镜时间越长,损害越大。

Effects of long-term soft contact lens wear on the corneal and conjunctival epithelial changes

·AIM:To observe the difference of corneal and conjunctival epithelial changes between normal subjects and subjects with long-term soft contact lens(SCL)wear(>5 years)and to probe the possible effects and mechanism on ocular surface with long-term SCL wear among university students.·METHODS:In this study,fluorescein vital staining(FLS),conjunctival imperssion cytology(CIC)changes of long-term SCL wearers were used.The study included 198 eyes of 99 SCL wearers and 70 eyes of 35 subjects as control group.SCL wearers were divided into three groups of less than 5 years and 5 to 10 years and more than 10 years according to the duration of contact lens wear.The differences of FLS、goblet cell density(GCD)and grade of squamous metaplasia were analyzed.·RESULTS:There were statistical differences in FLS,GCD and grade of squamous metaplasia between the control group and the groups wearing SCL(P<0.01);There were statistical differences in GCD and grade of squamous metaplasia between the group wearing SCL for of less than 5 years and 5 to 10 years and more than 10 years(P<0.01);but there were not statistically differences in GCD and grade of squamous metaplasia between the group wearing SCL for 5 to 10 years and more than 10 years;There were positive correlations between grade of squamous metaplasia and FLS(r=0.589,P<0.01);but negative correlations between GCD and FLS(r=-0.351,P<0.01).·CONCLUSION:Long-term and extended wear SCL caused the corneal epithelial injury,and CIC changes,the longer wear,the greater the damage.There are significant correlations between GCD or CIC grading and FLS.GCD and CIC grading can be used to assess the ocular surface conditions of long-term and prolonging SCL wear.·