长期佩带角膜接触镜对角膜上皮细胞凋亡的影响

Effect of wearing of soft corneal contact lens for long term on apoptosis of corneal epithelial cell

背景配戴软性角膜接触镜作为矫正屈光不正的主要方法之一目前已广泛应用，临床上对其不良反应的研究已有报道，但是其对人角膜上皮细胞凋亡的影响研究甚少。目的检测长期佩戴软性角膜接触镜者与未配戴者的角膜上皮细胞的凋亡情况并进行对比，了解长期佩戴软性角膜接触镜对人眼角膜上皮细胞增生修复的影响。方法采用回顾性巢式病例对照研究设计，纳入2010年10月至2011年6月在贵阳医学院附属医院就诊的行去瓣式机械法准分子激光角膜上皮瓣下磨镶术（Epi—LASIK）的患者40例80眼，其中包括长期佩戴软性角膜接触镜（≥5年）的近视患者20例40眼（戴镜组）及未配戴软性角膜接触镜的近视患者20例40眼（未戴镜组），在去瓣式Epi—LASIK术中收集患者的角膜上皮瓣，利用流式细胞技术检测角膜上皮细胞凋亡情况，并分析两组问角膜上皮细胞凋亡比例的差异。结果角膜上皮细胞凋亡流式细胞图显示，戴镜组患者角膜上皮annexinV高染、碘化丙啶（PI）低染的早期凋亡细胞群多于未戴镜组，而annexinV、PI均低染的角膜上皮活细胞群少于未戴镜组，annexinV、PI均高染的坏死细胞或晚期凋亡细胞多于未戴镜组。戴镜组角膜上皮细胞早期凋亡比例为（11．23±5．31）％，未戴镜组为（7．31±5．43）％，差异有统计学意义（t=2．754，P=0．008）。结论长期佩戴软性角膜接触镜可造成角膜上皮细胞的早期凋亡细胞比例增多，进一步证明角膜上皮长期处于损伤、增生修复、愈合到再损伤的过程，可能导致眼表结构及功能的紊乱。

Background Wearing of soft contact lens,as one of the important methods to correct ametropia, has been widely applied at present. The clinically deleterious effects of soft contact lens have been reported, but researches about influence of apoptosis of corneal epithelial cells are scant. Objective This study was to detect and compare the ratio of apoptosis of corneal epithelial ceils between the patients with contact lens wearing and without contact lens wearing, and explore the influence of soft contact lens wearing for long term on growth of corneal epithelial cells after injury. Methods A retrospective nest case-controlled study was designed. Forty eyes of 20 myopic patients with wearing of soft contact lens for ≥5 years and 40 eyes of 20 myopic patients without wearing of soft contact lens were included in Affiliated Hospital of Guiyang Medical College. All the patients received the off-flap epipolis laser in situ keratomileusis （Epi-LASIK） from 2010 October to 2011 June. The corneal flaps were collected during the surgery. The apoptosis of corneal epithelial cells was detected by flow cytometry（FCM） , and the difference of apoptotic proportion between the two groups was compared using independent sample t test. Results The FCM scatter plot showed that compared to the without contact lens wearing group,the early stage of apoptotic ceils with high staining annexin V and low staining proaium iodide （PI） were much more, and survival cells with low staining annexin V and PI were less,and necrotic and late stage of apoptotic cells with high staining of annexin V/PI were more in the with contact lens wearing group. The early stage of apoptosis proportion of corneal epithelial cells was （ 11.23 ± 5.31） % in the with contact lens wearing group, and that in the without contact lens wearing group was （7.31 ±5.43） % ,showing a significant difference between them （ t = 2. 754, P = 0. 008 ）. Conclusions A long term wearing of contact lens induce more apoptosis of corneal epithelial cells, which can result in a disorder of structure and function of ocular surface during the wound healing stage.