基于功能性裂隙灯生物显微镜对巩膜镜初戴者球结膜微循环改变的研究

Functional slit lamp biomicroscopy for imaging bulbar conjunctival microvasculature in scleral lenses wearers

目的:比较巩膜镜初戴者戴镜前、后的球结膜微循环的改变,观察配戴巩膜镜对球结膜微循环的影响。方法:前瞻性临床研究。共纳入温州医科大学从未配戴过巩膜镜的在校健康学生22名,所有被检者根据随机数字表法随机选择一眼进行数据采集,配戴巩膜镜。使用功能性裂隙灯生物显微镜(FSLB)分别于戴镜前,戴镜0、1、2、3 h拍摄颞侧巩膜镜镜下和镜外区域的球结膜获得球结膜微循环和微血管影像,并使用自行编写的软件测量获得微循环及微血管参数。采用单因素方差分析法分析戴镜前/后、镜下/镜外的球结膜微循环及微血管参数之间的差异,并采用Pearson相关分析方法进行相关性分析。结果:纳入22名被检者的22只眼(13只右眼,9只左眼),在眼表微血管形态方面,镜外区域戴镜0 h时血管密度(1.482±0.100)较戴镜前血管密度(1.408±0.124)明显升高(P=0.019)。在眼表微循环方面,镜外区域戴镜前血流量[(104.5±28.4)pl/s]高于戴镜1 h时血流量[(86.1±20.9)pl/s](P=0.027);镜下区域血管直径在戴镜3 h时[(18.39±1.90)μm]与戴镜前[(17.71±1.49)μm]、戴镜0 h[(17.63±2.11)μm]、戴镜1 h[(17.85±1.86)μm]时差异均有统计学意义(均P<0.05),戴镜0 h较戴镜前降低,戴镜1~3 h血管直径逐渐升高;血流量在戴镜1 h[(61.6±22.8)pl/s]时与戴镜前[(77.4±27.0)pl/s)、戴镜3 h[(76.9±22.3)pl/s]差异均有统计学意义(均P<0.05),戴镜1 h较戴镜前明显降低,戴镜3 h较戴镜1 h时明显升高。结论:配戴巩膜镜初期,结膜受巩膜镜压力出现一过性循环障碍,之后因眼表逐渐适应巩膜镜以及巩膜镜对眼表的炎性刺激使球结膜的微循环升高。这提示使用FSLB量化获得的球结膜的微循环参数或许可以作为巩膜镜适配的客观准确的可视化工具,并可用于监测巩膜镜长期配戴者的球结膜血管系统,为巩膜镜配戴的安全性及配戴者的眼表健康提供线索。

Objective:To explore the changes of microcirculation of the bulbar conjunctiva after wearing the scleral lenses.Method:Prospective clinical study.The healthy students from Wenzhou Medical University were included in this study.The subjects randomly selected one eye as the experimental subject according to the random number table,the experimental subject wore scleral lenses.Functional slit lamp biomicroscopy(FSLB)was used to capture temporal bulbar conjunctival microcirculation and microvascular images under the lenses and outside of the lenses before and during the wear at 0 h,1 h,2 h and 3 h.Custom-built software has been utilized for the quantification of microvascular morphology and hemodynamics.The changes of the indicators before and during wearing the scleral lenses were observed.The microcirculation and microvascular parameters were analysed using ANOVA and Pearson correlation.Result:22 subjects were enrolled in the study,including 13 right eyes and 9 left eyes.Outside of the scleral lenses,the vessel density before wearing lenses(1.408±0.124)was less than that at 0 h(1.482±0.100)(P=0.019).Outside of the scleral lenses,the blood flow volume was(104.5±28.4)pl/s before wearing lenses and(86.1±20.9)pl/s after wearing 1 h.The comparison before and after wearing the scleral lenses was statistically significant(P=0.027).Under the scleral lenses,the vessel diameter at 3 h(18.39±1.90)μm was statistically significant(P<0.05)from before wearing the lenses(17.71±1.49)μm and after wearing the lenses at 0 h(17.63±2.11)μm,1 h(17.85±1.86)μm.The vessel diameter at 0 h after lens insertion was decreased than before lens wearing,however,the vessel diameter was increased after 1,3 h wearing.The blood flow volume at 1 h[(61.6±22.8)pl/s]was less than that before wearing lenses(77.4±27.0)pl/s and at 3 h[(76.9±22.3)pl/s](P<0.05).The comparison of 1 h after wearing the scleral lenses and before wearing lenses,3 h after wearing the scleral lenses was statistically significant.Conclusion:At the beginning of wearing the scleral lenses,the bulbar conjunctival vessels suffered transient circulatory disturbance due to the pressure of the scleral lens.Then the microcirculation of the bulbar conjunctiva increased due to the gradual adaptation of the scleral lenses and the inflammatory stimulation.The study of the conjunctival microcirculation and microvascular may contribute to explore the safety of wearing the ScCL and monitoring conjunctiva vascular system in long-term scleral lenses wearers.