配戴RGPCL和SCL后角膜组织病理学变化的比较

目的 探讨配戴硬性透气性角膜接触镜（RGPCL）和软性角膜接触镜（SCL）对角膜组织的影响.方法 病例对照研究.高度近视患者60例,30例配戴RGPCL,30例配戴SCL.在配戴3、6、12个月后,应用激光共焦显微镜检查两组患者的中央角膜和周边角膜上皮层、上皮下Langerhans细胞、神经纤维、角膜基质层、角膜内皮细胞及角膜厚度的变化.采用两因素方差分析对数据进行分析.结果 戴镜1年后,SCL组中央角膜表层细胞密度低于RGPCL组（F=4.262,P＜0.05）,上皮层可见微小囊泡及类似角膜营养不良的角膜小滴,上皮下Langerhans细胞密度及神经纤维曲折度均大于RGPCL组（F=5.362,P＜0.05;F=-14.910,P＜0.05）.SCL组中央角膜浅基质层细胞密度低于RGPCL组（P＜0.05）,基质层中各层白色点状物密度均高于RGPCL组（P＜0.05）.SCL组内皮细胞形态变化较RGPCL组明显,但两组内皮细胞密度差异无统计学意义.SCL组中央角膜上皮层厚度小于RGPCL组（F=-2.061,P＜0.05）.同一戴镜组内各个观察指标在3个月、6个月、12个月间的差异均无统计学意义.结论 RGPCL配戴者角膜上皮细胞、前基质细胞、内皮细胞、Langerhans细胞及神经纤维的变化均轻于SCL配戴者,提示RGPCL的安全性更高.

Comparison of corneal histopathology changes between the rigid gas permeable contact lens wearers and the soft contact lens wearers

Objective To investigate the corneal morphologic changes induced by wearing rigid gas permeable contact lenses (RGPCL) and soft contact lenses (SCL). Methods It was a case-control study. Sixty high myopia subjects participated in the study. Thirty were given RGPCL and 30 were given SCL Three, 6 and 12 months after wearing the contact lenses, confocal microscopy was used to observe the central and peripheral corneal epithelial cells, the density of the Langerhans cells,nerve fibers, corneal stroma, and endothelial cells of the 2 groups. A two-way ANOVA was used to analyze the data. Results Twelve months after contact lens wearing, the epithelial cell density of the corneal surface was lower in the SCL group than in the RGPCL group (F=4.262, P＜0.05), and corneal vesicles and corneal gutata were occasionally observed. The density of the Langerhans cells both in the central and peripheral cornea was higher in the SCL group (F=5.362, P＜0.05;F=-14.910, P＜0.05), and the tortuosity of the nerve fibers increased significantly in the eyes of those wearing SCL compared with those wearing RGPCL. The density of the anterior stromal cells was lower (P＜0.05) while the microdot densities in the stroma were higher in the SCL group than in the RGPCL group (P＜0.05). The polymorphology of the corneal endothelial cells was more apparent in the SCL group, but the density of the endothelial cells was similar for the 2 groups. The thickness of the central corneal epithelium was thinner for SCL wearers compared to RGPCL wearers (F=-2.061, P＜0.05). There were no differences for all of the indices within the same group at 3 months, 6 months and 12 months. Conclusion The corneal morphologic changes of RGPCL wearers are less severe than those of SCL wearers, suggesting that RGPCL wearing is a safe correction method.