發(fā)布時(shí)間：2018-11-04 17:07

【摘要】：目的：探討主視眼和非主視眼與年齡相關(guān)性白內(nèi)障發(fā)病的關(guān)系,為年齡相關(guān)性白內(nèi)障發(fā)病機(jī)制的研究及治療提供新的思路和理論依據(jù)。 方法：選取雙眼病變程度相近的皮質(zhì)性年齡相關(guān)性白內(nèi)障(Age-related cataract, ARC)患者30例共60只眼,雙眼視力相差不超過兩行視標(biāo)；年齡53-84歲,平均69.2±8.9歲。行雙眼超聲乳化加后房型人工晶體植入術(shù)。分別于術(shù)前及術(shù)后一周確定主視眼和非主視眼的眼別；術(shù)前分別測(cè)量主視眼和非主視眼在自然狀態(tài)下和縮瞳后的晶體厚度；取術(shù)中撕取的中央部晶體前囊膜做HE染色,進(jìn)行晶體囊膜上皮細(xì)胞(Lens epithelial cells, LEC)計(jì)數(shù)；并通過透射電鏡觀察主視眼和非主視眼LEC超微結(jié)構(gòu)的變化。正常對(duì)照組為用于角膜移植的健康供體眼球晶體囊膜共4例,年齡28～40歲,平均34歲,HE染色后進(jìn)行LEC計(jì)數(shù)。 結(jié)果：病例組30例患者平均視力：主視眼組0.34±0.11,非主視眼組0.35±0.12,手術(shù)前后未出現(xiàn)主視眼轉(zhuǎn)換情況；主視眼組和非主視眼組在自然狀態(tài)下和縮瞳后的晶體厚度變化差值有顯著統(tǒng)計(jì)學(xué)意義(P0.01)；主視眼組和非主視眼組的LEC密度分別為(3606±429)個(gè)/mm2和(3913±433)個(gè)/mm2,其差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。正常對(duì)照組的LEC平均密度為(4735±108)個(gè)/mm2,與病例組比較差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01)；透射電鏡觀察主視眼的LEC密度較非主視眼降低,上皮細(xì)胞大小形態(tài)不一,異常細(xì)胞表現(xiàn)為細(xì)胞間隙增大,甚至呈空泡樣改變,細(xì)胞核多呈圓形,部分細(xì)胞的細(xì)胞器腫脹,胞膜溶解；部分細(xì)胞皺縮,染色質(zhì)固縮周邊化,呈早期凋亡改變。 結(jié)論：在視覺活動(dòng)中,主視眼的晶體厚度變化明顯大于非主視眼；主視眼的LEC平均密度小于非主視眼；ARC患者的LEC密度明顯小于正常對(duì)照組。ARC較多先發(fā)生于主視眼,推測(cè)原因?yàn)槠湓谌粘Ｒ曈X活動(dòng)中動(dòng)用的調(diào)節(jié)度大,進(jìn)入眼內(nèi)的光線量大,引起眼內(nèi)微環(huán)境的變化,造成了LEC的損傷,導(dǎo)致細(xì)胞密度的減少,從而導(dǎo)致白內(nèi)障的發(fā)生。
[Abstract]:Objective: to explore the relationship between primary and undominant eyes and age-related cataract, and to provide new ideas and theoretical basis for the study and treatment of age-related cataract. Methods: 60 eyes of 30 Age-related cataract, ARC) patients with cortical age-related cataract with similar degree of binocular lesion were selected. The visual acuity difference between the two eyes was not more than two lines, the age was 53-84 years (mean 69.2 鹵8.9 years). Bilateral phacoemulsification and posterior chamber intraocular lens implantation were performed. Before and one week after operation, the main eye and the non-main eye were determined, and the lens thickness of the primary eye and the non-primary eye were measured in the natural state and after pupil constriction, respectively. The anterior capsular membrane of the central lens was stained with HE to count the (Lens epithelial cells, LEC) of the epithelial cells and the ultrastructure of LEC in the primary and non-primary eyes was observed by transmission electron microscope. The normal control group consisted of 4 cases of normal donor lens capsule for corneal transplantation, aged 2840 years (mean 34 years). LEC was counted after HE staining. Results: the average visual acuity of 30 patients in the case group was 0.34 鹵0.11 in the primary eye group and 0.35 鹵0.12 in the non-main visual eye group. The difference of lens thickness between the primary eye group and the non-primary eye group was statistically significant (P0.01). The density of LEC was (3606 鹵429) / mm2 and (3913 鹵433) / mm2, in the primary eye group and the non-main eye group respectively. There was significant difference between the two groups (P0.01). The average density of LEC in the normal control group was (4735 鹵10 8) / mm2, which was significantly different from that in the case group (P0.01). The LEC density of the primary eye was lower than that of the non-primary eye, and the size of epithelial cells was different. The abnormal cells showed enlarged intercellular space, even vacuolar changes, round nuclei and swelling of some cell organelles. Membrane dissolution; Some cells crumpled, chromatin pyknosis surrounding, early apoptotic changes. Conclusion: the change of lens thickness in the primary eye is obviously larger than that in the non-main eye, and the average density of LEC in the main eye is smaller than that in the non-main eye. The density of LEC in ARC patients was significantly lower than that in the normal control group. ARC occurred in the primary eye first, presumably because of its large regulation in daily visual activities and the large amount of light entering into the eye, which resulted in the change of the microenvironment in the eye. It causes damage to LEC, reduces cell density, and leads to cataract.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R776.1

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