The impact of lens care solutions on corneal epithelial changes during daily silicone hydrogel contact lens wear as measured by in vivo confocal microscopy

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• 作者：Xiaolin Zhang^a ; Christine Marchetti^a ; Jessica Lee^a ; Yan Sun^a ; Sara Debanne^b ; Ying Jiang^b ; Jami Kern^c ; Mark Harrod^a ; Beth Ann Benetz^a ; Eric Pearlman^a ; ^d ; Loretta Szczotka-Flynn^a ; ^{loretta.szczotka@uhhospitals.org}
• 关键词：Confocal microscopy ; Silicone hydrogel contact lens ; Hyper-reflective corneal epithelial cells
• 刊名：Contact Lens and Anterior Eye
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：40
• 期：1
• 页码：33-41
• 全文大小：981 K
• 卷排序：40

文摘

To assess corneal epithelial microstructure via confocal microscopy and determine if cellular changes are associated with lens care solutions during daily wear of silicone hydrogel contact lenses.MethodsCorneal in vivo confocal microscopy with the Nidek ConfoScan4 was performed at baseline and after 5 months of lotrafilcon A daily contact lens wear. Enrolled participants were randomized to use either a polyhexamethylene biguanide (PHMB) preserved multipurpose care solution (MPS) or a peroxide based solution system. Lens and storage case bioburden were assessed with aerobic culture methods. Univariate and multivariable analyses were done to evaluate the association between solution use, or solution-related clinical covariates, and morphologic differences (hyper-reflectivity) in the superficial epithelial cells and epithelial basal cell density.ResultsData on 139 participants were available for analysis of superficial epithelial cells while data on 92 participants were available for epithelial basal cell density. Five months after randomization to the solution groups, 33% of participants had visible hyper-reflective cells. More participants using MPS had ≥1 hyper-reflective cells compared to peroxide users at 5 months (44% vs. 22%; p = 0.006). Similarly at 5 months, more participants with solution-induced corneal staining (SICS) had ≥1 hyper-reflective cells compared to non-SICS participants (57% vs. 29%; p = 0.010). The adjusted odds ratios (ORs) for risk of presenting with hyper-reflective cells in MPS users or SICS participants was 2.7 (95% CI; 1.27–5.65) and 3.4 (95% CI; 1.29–8.97), respectively. Basal cell density decreased by over 350 cells/mm2 over time (about 6%) in participants who had substantial bioburden on their lenses or in their storage case.ConclusionThe confocal microscope can detect epithelial cellular changes in vivo during contact lens wear. Hyper-reflective superficial epithelial cells are associated with a PHMB preserved solution and decreases in basal epithelial cell density may be associated with bacterial bioburden.