本文選題：顯微鏡檢查 + 共焦��； 參考：《青島大學(xué)》2011年碩士論文

【摘要】：目的應(yīng)用共焦顯微鏡觀查近視青少年配戴透氣性硬性角膜接觸鏡(Rid gas permeable contact lens,簡稱RGPCL)在不同時期角膜組織的變化,客觀評價配戴透氣性硬性角膜接觸鏡對青少年角膜組織近期的影響。 方法選取2009年3月至2010年7月在滄州眼科醫(yī)院進(jìn)行RGPCL矯正治療的青少年近視患者45例,所有患者均為雙眼戴鏡。根據(jù)屈光度不同分為兩個觀察組,Ⅰ組27例為夜戴組,近視度≤-5.00D且散光度-1.25D者；Ⅱ組18例為日戴組,近視度-5.00D且散光度≤-1.75D者。在兩組患者戴鏡6個月內(nèi)定期行眼部檢查及共焦顯微鏡檢查。戴鏡前為對照組,戴鏡后為實(shí)驗(yàn)組,觀察患者裸眼視力、矯正視力及屈光度的變化,并使用共焦顯微鏡對患者角膜進(jìn)行檢查,取中央角膜和上方角鞏膜緣內(nèi)2mm處角膜為檢查點(diǎn),取上皮波、神經(jīng)纖維波、基質(zhì)波、內(nèi)皮波完整的Z-SCAN圖像進(jìn)行分析,角膜各層的掃描圖像通過液晶顯示器同步顯示記錄,并利用內(nèi)置計(jì)數(shù)軟件計(jì)算角膜各層細(xì)胞密度和角膜各層厚度的變化。 結(jié)果 (1)裸眼視力及屈光度：Ⅰ組54眼戴鏡后6月與戴鏡前相比,裸眼視力明顯提高(t=30.604；p=0.000),屈光度明顯下降(t=18.324；p=0.000),差異有統(tǒng)計(jì)學(xué)意義；Ⅱ組36眼戴鏡后6月與戴鏡前相比,裸眼視力無明顯提高(t=1.414；p=0.162),屈光度無明顯下降(t=0.476；p=0.636),差異無統(tǒng)計(jì)學(xué)意義。 (2)角膜各層細(xì)胞密度： ①上皮細(xì)胞層：Ⅰ組患者中央角膜上皮細(xì)胞密度戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.597,p=0.001),戴鏡后2月至6月與戴鏡前相比明顯減少(q=4.189,4.473,4.642；p=0.042,0.031,0.029)。Ⅰ組患者周邊角膜上皮細(xì)胞密度戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.803,p=0.001),戴鏡后2月至6月與戴鏡前相比明顯增加(q=4.229,4.505,4.844；p=0.039,0.030,0.019)。Ⅱ組患者角膜中央和周邊上皮細(xì)胞密度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=0.736,0.464；p=0.642,0.860)。Ⅰ組患者戴鏡后中央及周邊角膜上皮內(nèi)朗格罕細(xì)胞密度與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.733,3.486；p=0.001,0.001),戴鏡后3月至6月與戴鏡前相比明顯增加(中央q=4.410,4.991；p=0.036,0.013；周邊q=4.439,4.951；p=0.034,0.015)。Ⅱ組患者戴鏡后中央及周邊角膜上皮內(nèi)朗格罕細(xì)胞密度與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=1.667,1.381；p=0.117,0.213) ②淺基質(zhì)層：Ⅰ組患者角膜中央和周邊淺基質(zhì)層細(xì)胞密度戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.230,3.409；p=0.002,0.002),戴鏡后2月至6月與戴鏡前相比明顯減少(中央q=4.203,4.373,4.876；p=0.041、0.039、0.017；周邊q=4.284,4.682,4.981；p=0.035,0.021,0.014)。Ⅱ組患者角膜中央和周邊淺基質(zhì)層細(xì)胞密度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=1.083,0.632；p=0.374,0.729) ③深基質(zhì)層：Ⅰ組患者角膜中央和周邊深基質(zhì)層細(xì)胞密度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=1.176,1.867；p=0.316,0.074)。Ⅱ組患者角膜中央和周邊深基質(zhì)層細(xì)胞密度戴鏡后與戴鏡前相比,差異亦無統(tǒng)計(jì)學(xué)意義(F=0.746,0.674；p=0.633,0.694)。 ④內(nèi)皮細(xì)胞層：Ⅰ組患者角膜中央和周邊內(nèi)皮細(xì)胞密度戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.351,3.080；p=0.002,0.004)。中央角膜平均細(xì)胞面積、六角形細(xì)胞百分率戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.577,3.911；p=0.001,0.001),尤其戴鏡后2月至6月與戴鏡前相比,平均細(xì)胞面積增大(q=4.302,4.467,4.727；p=0.034,0.032,0.024),六角形細(xì)胞百分率下降(q=4.267,4.664,5.359；p=0.036,0.021,0.006)。Ⅱ組患者角膜中央和周邊內(nèi)皮細(xì)胞密度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=0.915,0.658；p=0.495,0.708)。中央角膜平均細(xì)胞面積、六角形細(xì)胞百分率戴鏡后與戴鏡前相比,差異亦無統(tǒng)計(jì)學(xué)意義(F=0.710,0.793；p=0.663,0.594)。 (3)角膜厚度變化 ①上皮厚度 Ⅰ組患者中央角膜上皮層厚度戴鏡后與戴鏡前相比,差異有統(tǒng)計(jì)學(xué)意義(F=3.339,p=0.002),尤其戴鏡后3月至6月與戴鏡前相比明顯變薄(q=4.420,4.577；p=0.035,0.033)。Ⅰ組患者周邊角膜上皮層厚度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=1.096,p=0.365)。Ⅱ組患者中央及周邊角膜上皮層厚度戴鏡后與戴鏡前相比,差異無統(tǒng)計(jì)學(xué)意義(F=1.024,0.727；p=0.414,0.649)。 ②基質(zhì)厚度 Ⅰ組患者中央及周邊角膜基質(zhì)層厚度戴鏡后與戴鏡前相比差異無統(tǒng)計(jì)學(xué)意義(F=0.929,0.729；p=0.484,0.648)。Ⅱ組患者中央及周邊角膜基質(zhì)層厚度戴鏡后與戴鏡前相比差異亦無統(tǒng)計(jì)學(xué)意義(F=0.859,0.461；p=0.540,0.862)。 ③全層厚度 Ⅰ組患者中央及周邊角膜全層厚度戴鏡后與戴鏡前相比差異無統(tǒng)計(jì)學(xué)意義(F=1.359,0.408；p=0.221,0.897)。Ⅱ組患者中央及周邊角膜全層厚度戴鏡后與戴鏡前相比差異亦無統(tǒng)計(jì)學(xué)意義(F=1.066,0.577；p=0.386,0.775)。 結(jié)論 1.近視度≤-5.00D且散光度-1.25D)的青少年近視患者夜戴RGPCL近期能提高裸眼視力,降低屈光度,但會對角膜形態(tài)學(xué)造成明顯影響。 2.近視度-5.00D且散光度≤-1.75D的青少年近視患者日戴RGPCL近期不能提高裸眼視力及降低屈光度,不會對角膜形態(tài)學(xué)造成明顯影響。 3.應(yīng)用共焦顯微鏡檢查可評估透氣性硬性角膜接觸鏡對角膜組織的形態(tài)學(xué)影響。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R778.11

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