摘要
目的研究准分子激光原位磨镶术(LASIK)负压吸引环对结膜杯状细胞密度(GCD),黏蛋白MUC5AC量的影响以及GCD、MUC5AC和泪膜变化的相关性。为探讨LASIK术后干眼症状发病机制提供可能的依据,为临床上寻找有效的预防和治疗LASIK术后干眼的方法提供参考依据。
方法选30位做LASIK近视矫正术的病人(60只眼),每只眼的球结膜选取两个位点采用印迹细胞学取样。取样时间分别是术前、术后1周、术后1月、术后3月,过碘酸-希夫试剂染色(PAS)后计算GCD。记录负压吸引环吸引时间(ST),观察术前、术后1周、术后1月、术后3月患者的泪膜破裂时间(BUT)、schirmer实验Ⅰ的值、角膜荧光素染色评分(FLU)。检测术前术后泪液总蛋白的量,黏蛋白MUC5AC的吸光度值(OD)。对ST、术后不同时间的BUT、schirmer值、FLU与GCD做相关性分析,对术后不同时间的GCD、BUT、schirmer值、FLU与OD值做相关性分析。
结果ST为10~26 s。术后GCD、BUT、shirmer值、FLU、OD值与术前相比下降,差异有统计学意义(P<0.01)。术后泪液总蛋白量与术前相比无统计学差异。术后1周、1月GCD和ST成负相关,术后3月GCD和ST无相关性。术后1周、1月、3月BUT和GCD成正相关。术后1周、1月schirmer值与GCD呈正相关,术后3月的schirmer值与GCD无相关性。术后1周、1月FLU与GCD呈负相关,术后3月FLU与GCD无相关性。术后1周、1月、3月GCD、BUT和OD值成正相关。术后1周schirmer值与OD值成正相关,术后1月、3月schirmer值与OD值无相关性。术后1周、1月、3月FLU与GCD无相关性。术后1周、1月、3月GCD、BUT和OD值成正相关。术后1周schirmer值与OD值成正相关,术后1月、3月schirmer值与OD值无相关性。术后1周、1月、3月FLU与GCD无相关性。
结论术后泪膜稳定性下降。结膜印迹细胞学提示LASIK术后负压吸引环施压处结膜杯状细胞密度降低,下降程度可能与施压时间长短有关。术后黏蛋白MUC5AC的OD值下降。泪膜稳定性的改变可能与杯状细胞的减少,黏蛋白MUC5AC的量下降有关。
Objective To study the changes of conjunctival goblet cells density(GCD) and the content of mucin MUC5AC after suction ring application in LASIK and the relation between the changes of goblet cells density , MUC5AC and tear films’stability. To investigate the possible pathogenesy of dry eye after LASIK and to provide methods for preventing and treating dry eye after LASIK.
Methods Conjunctival impression cytology was used to collect samples on 60 eyes that underwent LASIK for the correction of myopia. Four pairs of samples were taken on each eye at different times. The first pair was taken preoperatively before application of the suction ring. The second,third and fourth pair were taken from the same sites at 1 week,1 month and 3 month after surgery consecutively.The samples were stained with Periodic Acid Schiff’s (PAS) and GCD was measured.Suction time(ST), breakup time of tear films (BUT),schirmer values and corneal fluorescein staining (FLU),the content fo total protein in tear films and OD of MUC5AC were observed preoperatively,1 week,1 month,3 month postoperatively.Correlations were used to determine the significance of relation between the postoperative GCD and ST, BUT,schirmer values and FLU. Correlations were used to determine the significance of relation between the postoperative OD and GCD,BUT ,schirmer values and FLU.
Results ST was 10~26s.Compared with peroperative one,postoperative GCD, BUT,shirmer values、FLU、OD showed a statistically significant decrease respectively (P<0.01). Compared with peroperative one , postoperative content of total protein in tear films showed no statistically significant.There was a negative correlation between ST and GCD at 1 week and 1 month after surgery.There was a positive correlation between BUT and GCD postoperatively. Schirmer values were positively correlated with GCD at 1 week and 1 month after surgery. FLU was negatively correlated with GCD at 1 week and 1 month postoperatively. Schirmer values and FLU had no correlation with GCD at 3 month postoperatively. GCD and BUT were positively correlated with OD at 1 week、1 month and 3 month postoperatively. Schirmer values were positively correlated with OD at 1 week postoperatively.There was no correlation between Schirmer values and OD at 1 month and 3 month postoperatively. There was no correlation between FLU and OD at 1 week,1 month and 3 month postoperatively.
Conclusion The stability of tear films was decreased after LASIK.Impression cytology showed reduction in goblet cell density where the suction ring exerted pressure on the conjunctiva, probably because of the length of the suction time. The OD of MUC5AC was decreased afer LASIK.And the loss of goblet cells and MUC5AC may contribute to the changes in tear films’stability. .
引文
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