女性角膜接触镜佩戴者月经周期对眼表改变研究

Ocular surface changes during menstrual cycle in women wearing contact lens

目的对比女性佩戴软性角膜接触镜前后月经周期对眼表症状与体征的影响。方法于2014年6-12月在福建省立医院眼科收集中低度近视女性14例，分别在戴镜前与戴镜2月后选取月经周期间3个时间点（分别为卵泡期、排卵期、黄体期）进行眼表疾病指数（OSDI）评分，测量角膜中央厚度（CCT）、角膜荧光素染色（FL）评分、基础泪液分泌量（st）及泪膜破裂时间（BUT）。采用单因素方差分析比较月经周期内检查结果，采用配对f检验比较戴镜前后检查结果。结果戴镜前后CCT在排卵期与黄体期均较卵泡期增厚，差异有统计学意义（P均〈0．01）。戴镜前OSDI评分、Fl评分、St及BUT在卵泡周期3组问比较均无统计学意义（P均〉0．05），而戴镜后OSDI评分在排卵期与黄体期均高于卵泡期（P均〈0．05），BUT在排卵期与黄体期均短于卵泡期（P均〈0．05）。戴镜后较戴镜前OSDI评分增高，CCT增厚，Fl评分增高，BUT缩短，差异有统计学意义（P均〈0．05），但St与戴镜前比较均差异无统计学意义（P均〉0．05）。结论女性佩戴角膜接触镜后眼表症状与泪膜稳定性受月经周期影响，而戴镜前未受影响，提示角膜接触镜可能加剧雌激素对女性眼表产生的亚临床改变。

Objective To compare the changes in subjective symptoms and ocular surface parameters during menstrual cycle before and after wearing soft contact lens. Methods Fourteen women with low to moderate myopia were enrolled in this prospective study. All participants underwent full eye examinations including Ocular Surface Disease index （OSDI） scores, tearfilm break-up time （BUT）, fluorescein staining （Fl） scores, Schirmer Ⅰ tests （St）, and central corneal thickness （CCT） at follicular phase, at ovulatory phase, and at luteal phase during their menstrual cycle. All examinations were performed before fitting with contact lens and after two months wear. One-way ANOVA was applied to compare the parameters during the menstrual cycle, and paired Student＇s t test was applied to compare the parameters before and after contact lens wear. Results The CCT was statistically increased at ovulatory and luteal phase compared with the follicular phase before and after contact lens wear （P 〈0.01 for all）. No significant change was found in OSDI scores, BUT, Fl scores, and St during menstrual cycle before contact lens wear （P 〉0.05 for all）. However, after contact lens wear, the OSDI scores at ovulatory and luteal phase were higher than that of at follicular phase （P 〈 0.05 for all）. The BUT at ovulatory and luteal phase were shorter than that of at follicular phase （P 〈 0.05 for all）. The OSDI scores were higher, CCT were thicker, BUT were shorter, Fl scores were higher in participant after contact lens wear than that of before wearing （P 〈 0.05 for all）, but St had no significant change before and after contact lens wear （P 〉 0.05）. Conclusions The subjunctive symptoms and the tear stability significantly vary during the menstrual cycle after contact lens wear indicate that contact lens wear may exacerbate the subclinical injury of ocular surface caused by fluctuations of oestrogen in female.