本文關鍵詞： 角膜 軟性接觸鏡 病理 免疫組化　出處：《泰山醫(yī)學院》2010年碩士論文　論文類型：學位論文

【摘要】：目的 通過對比的方法,研究長期配戴角膜軟性接觸鏡患者和從未配戴角膜軟性接觸鏡患者的角膜上皮,觀察角膜上皮組織的基底細胞數目、上皮厚度、基底細胞形態(tài)、PCNA等方面的不同變化,了解長期配戴角膜軟性接觸鏡對角膜的影響,從而為臨床提供有效的治療手段。 方法 1.選擇患者：選配戴角膜接觸鏡超過三年的患者和從未配戴角膜接觸鏡患者各33例。 2.實驗分組： (1)實驗組：配戴軟性角膜接觸鏡超過三年的患者33例66眼； 1)實驗A組：配戴軟性角膜接觸鏡超過三年的患者30例60眼,其中男性13例26眼,女性17例34眼,年齡18—41歲,平均27.38±5.66歲； 2)實驗B組：配戴軟性角膜接觸鏡超過三年的患者3例6眼,其中男性1例2眼,女性2例4眼； (2)對照組：從未配戴角膜接觸鏡患者33例66眼； 1)對照A組為從未配戴角膜接觸鏡患者30例60眼,其中男性15例30眼,女性15例30眼,年齡18—40歲,平均26.87±6.73歲； 2)對照B組為從未配戴角膜接觸鏡患者3例6眼,其中男性2例4眼,女性1例2眼。 3.取材：對所選患者,在準分子Flap-free Epi-LASIK手術中,用Epi-K角膜上皮刀取下角膜上皮瓣。 4.檢測(A組患者)： (1)厚度測量：將角膜上皮瓣展開,平放在載玻片上,采用超聲方法測量其厚度； (2)基底細胞計數： 1)角膜上皮瓣經過HE染色、固定、脫水、透明、封片后,在顯微鏡下觀察其基底細胞數目的變化； 2)將新鮮角膜上皮瓣經瑞氏染色,在顯微鏡下觀察其基底細胞數目的變化。 5.形態(tài)學觀察(B組患者)： 1)取角膜上皮瓣,經過固定、脫水、透明、包埋、切片、HE染色、固定、脫水、透明、封片后在病理顯微鏡下觀察角膜上皮瓣及其細胞形態(tài)的變化； 2)取角膜上皮瓣,常規(guī)切片,經免疫組織化學染色后,在高倍顯微鏡下進行增殖細胞核抗原(Proliferating Cell Nuclear Antigen簡稱PCNA)測定。 結果 1.通過超聲測量離體角膜上皮瓣的厚度,長期配戴角膜軟性接觸鏡組角膜上皮層厚度為55.33±4.56gm；對照組角膜上皮層厚度為57.19±3.82gm,二者之間有顯著差異,存在統(tǒng)計學意義(p0.05)。 2.通過顯微鏡下對離體角膜上皮瓣基底細胞的觀察,發(fā)現長期配戴角膜軟性接觸鏡組,基底上皮細胞數目減少,為3872.57±153.16個/mm2；對照組基底上皮細胞數目為3989.18±289.58個/mm2,二者之間有顯著差異,存在統(tǒng)計學意義(p0.01)。 3.通過形態(tài)變化的對比,可以見到長期配戴軟性角膜接觸鏡者角膜基底細胞細胞排列疏松,細胞形態(tài)欠規(guī)整,基底膜較厚,相對粗糙。 4.經過免疫組織化學標記,長期配戴軟性角膜接觸鏡者角膜上皮基底細胞發(fā)現PCNA陽性細胞,而從未配戴軟性角膜接觸鏡者沒有發(fā)現。 5.用Epi-K取下的角膜上皮瓣基底細胞完整,界面光滑平整,無基底細胞缺失,無基質細胞存在。 結論 1.長期配戴軟性角膜接觸鏡可導致角膜上皮損傷：使角膜上皮厚度變��；單位面積內的的角膜上皮基底細胞數量減少；可使角膜上皮的組織結構發(fā)生病理學改變,細胞形態(tài)發(fā)生改變,細胞之間的連接和基底膜遭到破壞,PCNA陽性細胞存在。 2. Epi-K角膜上皮刀可分離出完整的角膜上皮瓣,既不會有上皮細胞殘留,也不會損傷前彈力層,更不會損傷基質層,可以保留光滑的平面以備準分子激光切削。證實了Epi-K角膜上皮刀在準分子激光表面切削手術中有其獨特的優(yōu)越性。
[Abstract]:objective
Through the method of comparison research, long-term wearing soft contact lens patients and never wearing soft contact lens corneal epithelium, observe the number of basal cells of corneal epithelial tissue epithelial thickness, basal cell morphology, different aspects of the change of PCNA, understand the long term effect of wearing soft contact lens on corneal. In order to provide effective means for clinical treatment.
Method
1. patients were selected: 33 patients who were selected to wear corneal contact lenses for more than three years and those who had never worn contact lenses.
2. group of experiments:
(1) experimental group: 66 eyes of 33 patients who wore soft contact lens for more than three years;
1) in the experimental group A, 30 patients (60 eyes) with soft contact lenses for more than three years, including 13 males and 26 eyes, 17 females and 34 eyes, aged 18 to 41 years, with an average 27.38 27.38 years old.
2) experimental group B: 3 cases of 6 eyes with a soft contact lens for more than three years, including 1 males and 2 eyes, 2 women and 4 eyes.
(2) the control group: 66 eyes of 33 patients who had never worn the contact lens of the cornea.
1) 30 cases in the control group A were never worn with corneal contact lens. Among them, there were 15 cases of male 30 eyes, 15 women in 30 eyes, 18 to 40 years old and 26.87 + 6.73 years old.
2) in group B, 6 eyes were found in 3 patients who had never worn contact lenses. Among them, there were 2 cases in males, 4 in 4, and 2 in 1 cases in women.
3.: for the selected patients, in the excimer Flap-free Epi-LASIK operation, the upper corneal flap was removed with the Epi-K corneal epithelial knife.
4. detection (group A patients):
(1) thickness measurement: the skin flap of the cornea was expanded and placed on the slide plate, and the thickness of the flap was measured by ultrasonic method.
(2) basal cell count:
1) corneal flap after HE dyeing, fixation, dehydration, transparent, mounting, observe the change of the number of basal cells under the microscope;
2) the fresh corneal epithelial flap was stained by Rayleigh, and the number of basal cells was observed under the microscope.
5. morphological observation (group B patients):
1) take corneal flap, after fixation, dehydration, transparent, embedding, slice, HE dyeing, fixation, dehydration, transparent, every changes of corneal flap's and cell morphology under the microscope in pathology;
2) take the flap above the cornea and slice it routinely. After immunohistochemical staining, the Proliferating Cell Nuclear Antigen (PCNA) was detected under the high power microscope.
Result
1., the thickness of detached upper corneal flap was measured by ultrasound. The thickness of corneal epithelial layer was 55.33 + 4.56gm in long-term contact corneal contact lens group. The thickness of corneal epithelium in control group was 57.19 + 3.82gm, and there was a significant difference between the two groups (P0.05).
2. through the microscope for observation of corneal flap from the body of basal cells, found that long-term wearing soft contact lens group, basal epithelial cells were decreased in number, 3872.57 + 153.16 /mm2; the control group the number of basal epithelial cells was 3989.18 + 289.58 /mm2, there are significant differences between the two, there were statistical significance (P0.01).
3. through morphological contrast, we can see that long term wearing soft contact lens cells have loose cells, irregular cell shape, thicker basement membrane, and relatively rough.
4. after immunohistochemical labeling, PCNA positive cells were found in corneal epithelial basal cells after long-term wearing soft contact lenses, but no soft contact lenses were found.
5. the basal cells of the skin flap from Epi-K were complete, smooth and smooth, no basal cell deletion and no stromal cells.
conclusion
1. long term wearing soft contact lens can cause corneal epithelial injury: the corneal epithelial thickness; the corneal epithelial basal cell number decreased in the area; the structure of corneal epithelium occurred pathological changes, changes in cell morphology, the connection between cells and basement membrane destruction, the presence of PCNA positive cells.
2. Epi-K Epikeratome isolated intact corneal flap, neither residual epithelial cells, it will not damage the elastic layer, but will not damage the matrix layer, can keep a smooth surface for excimer laser. Confirmed that Epi-K Epikeratome has its unique superiority in excimer laser ablation surgery.

【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R772.2

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