睑内翻倒睫致眼表损伤对泪膜及上皮细胞稳定性影响

Affect of the stability of the tear film and ocular surface epithelial cells damage caused by entropion trichiasis

目的研究睑内翻倒睫所致的机械性损伤在矫正手术前后对角、结膜上皮细胞及泪膜稳定性的影响，并对术后的相应改善情况进行分析。方法临床病例系列研究。对2009年1-12月在吉林大学第二临床学院眼科就诊的60例（106只眼）睑内翻倒睫患者，按眼数分三组：先天性睑内翻组（n=41），老年性睑内翻组（n=45），瘢痕性睑内翻组（n=20），所有患者术前、术后1周及术后1个月分别行泪液分泌试验（schirmer test I，STI）、泪膜破裂时间（tear break-up time，BUT）、角膜荧光素染色（cornea fluorescein staining，crs）及结膜印迹细胞学（eonjunctival impression cytology，CIC）检查（根据Nelson分级），分别对比手术前、后的泪膜功能状态，杯状细胞密度及结膜上皮细胞鳞状化生程度。结果（1）与术前相比较，三组睑内翻倒睫患者行矫正手术后1周及1个月的泪液分泌量无明显变化（P〉0．05）。（2）三组睑内翻倒睫患者行矫正手术后与术前比较BUT明显延长，差异均有统计学意义（P〈0．05）。（3）通过三组患者手术前、后角膜荧光染色比较可以看出，各组睑内翻倒睫患者行矫正手术后，患者角膜程度不同恢复光滑透明，角膜荧光素着色减轻甚至消失，角膜荧光素染色评分的均值均下降，差异均有统计学意义（P〈0．05）。（4）先天性和老年性睑内翻患者术后的鳞状化生都有不同程度的降低，杯状细胞密度亦明显增加，差异有统计学意义（P〈0．05）。瘢痕性睑内翻患者术后鳞状化生程度有所降低（P〈0．05），但杯状细胞密度无明显增加（P〉0．05）。结论睑内翻倒睫所致的眼表机械性损伤可导致结膜上皮细胞鳞状化生，杯状细胞数量减少，角膜上皮完整性破坏及泪膜稳定性下降；及时且有效地睑内翻倒睫矫正术可明显改善上述情况。

Objective To investigate the effects of the mechanical injury of ocular surface by tri- chiasis to tear film and epithelial cell stability between pre-operation and post-operation, and the situ- ation of improvement of ocular microenvironment postoperatively. Methods In this study, 60 inpa- tients （106 eyes） due to trichiasis were randomly selected. According to the pathogenesis, all patients were divided into three groups： congenital entropion group （n =41）, senile entropion group （n =45） and cicatricial entropion group （n =20）. All enrolled patients in this study were examined by Schirm- er＇s I test （STI）, tear film break up time （BUT）, cornea fluorescein staining （CFS） and Conjunctival impression cytology （CIC） before surgery, one week and one month after surgery respectively. The re- suits such as functional status of the tear film, goblet cell density and the degree of squamous meta-plasia of conjunctival epithelial cells were compared between pre-operation with post-operation, and the degree of improvement of ocular surface microenvironment after operation were evaluated. Re- suits Compared to the results of pre-operation, there was no significant changes in tear secretion in three groups at 1 week and 1 month after operation （P 〉0.05）. The BUT of post-operation in three groups was much longer than the pre-operation＇s, there was statistical significance （P 〈0.05）. Com- pared with the results of pre-operation, the CFS was reduced or even disappeared in all cases after surgery, the score of CFS was decreased, there was statistically significant （P 〈0.05）. Moreover, the smoothly and transparently corneas were reappeared in most case after surgery. The squamous meta- plasia was decreased in different degree in the group of congenital and senile entropion after sur- gery. And the goblet cell density was increased at the same time. There was statistical significance （P 〈0.05）. The squamous metaplasia was decreased in the group of cicatricial entropion after surgery （P 〈0.05）, but there was no evident increase in goblet cell density （P 〉0.05）. Conclusions The per- sistent mechanical trauma by cilia in patients with entropion or trichiasis can induce the increase of conjunctival squamous metaplasia, the decrease of goblet cells density, the damage of the integrity of corneal epithelium and the stability of tear film. However, these changes can be reversed by an appropriately and timely surgical treatment.