角膜接触镜配戴前后球结膜微循环改变的临床研究

摘要

Objective To explore the changes of microcirculation of the bulbar conjunctiva after wearing the contact lens and the relationship between contact lens discomfort and bulbar conjunctiva microcirculation.Methods Prospective cohort study.The postgraduate students from School of Ophthalmology & Optometry and School of Biomedical Engineering of Wenzhou Medical University were included in this prospective cohort study.The subjects wore soft contact lenses,and the right eye was selected as the experimental eye.The ocular surface disease index (OSDI) questionnaire,Schirmer I and tear break-up time tests were completed before and after wearing the contact lens,and the conjunctival blood flow velocity and microvascular network density were also assessed by using functional slit lamp biomicroscopy.The changes of the indicators after wearing the contact lens were observed and the correlation between the subjective feelings of the wearers and the microcirculation parameters of the bulbar conjunctiva and the main factors affecting the subjective feelings of the wearers were analyzed.Results Twenty-seven subjects were enrolled in the study,including 8 males and 19 females,aged (22.7±1.6) years.The OSDI score was 11.860± 7.783 before wearing the contact lens and 24.017± 12.181 after wearing the contact lens.The comparison before and after wearing the contact lens was statistically significant (t=-4.356,P＜0.001).The conjunctival blood flow velocity was (0.534±0.132) mm/s before wearing the contact lens and (0.587±0.134) mm/s after wearing the contact lens.The comparison was statistically significant before and after wearing the lens (t=-2.076,P=0.048).OSDI was positively correlated with blood flow velocity at 1 month after wearing the contact lens (correlation coefficient r=0.383,P=0.048).The test results of the independent variables in the generalized estimating equation model showed that time and blood flow velocity were statistically significant (P＜0.05).Conclusions The blood flow velocity of the bulbar conjunctiva was increased after wearing the contact lens,and the contact lens discomfort of the wearers was positively correlated with the blood flow velocity of the bulbar conjunctiva.%目的 探讨角膜接触镜配戴前后球结膜微循环的改变及其与主观不适症状的关系.方法 前瞻性队列研究.本研究纳入温州医科大学眼视光学院、生物工程学院双眼配戴月抛软性角膜接触镜的在校研究生进行研究,取右眼作为实验对象.于戴镜前与戴镜后1个月进行眼表疾病指数(OSDI)量表填写,检查基础泪液分泌(Schirmer Ⅰ)试验和泪膜破裂时间(TBUT),并采用功能性裂隙灯生物显微镜对球结膜血流速度和微血管网密度进行评估,观察各指标在戴镜前后的变化并分析配戴者主观感受与球结膜微循环参数的相关性以及影响配戴者主观感受的主要因素.采用配对t检验分析戴镜前后的OSDI、血流速度、微血管网密度的差异;采用配对样本Wilcoxon符号秩和检验分析戴镜前后Schirmer Ⅰ和TBUT的差异.球结膜微循环参数与OSDI的相关性采用Pearson相关分析,与干眼指标的相关性采用Spearman秩相关分析;采用广义估计方程评估影响角膜接触镜配戴主观感受的主要因素.结果 27名受试者纳入本研究,其中男性8名,女性19名,年龄(22.7±1.6)岁.OSDI评分戴镜前为(11.860±7.783)分,戴镜后为(24.017±12.181)分,戴镜前后对比差异具有统计学意义(t=-4.356,P＜0.001),球结膜血流速度戴镜前为(0.534±0.132) mm/s,戴镜后为(0.587±0.134)mm/s,戴镜前后对比差异具有统计学意义(t=-2.076,P=0.048).戴镜后1个月OSDI与血流速度呈正相关(r=0.383,P=0.048),广义估计方程模型中自变量的检验结果显示,时间、血流速度均有统计学意义(P＜0.05).结论 角膜接触镜配戴后球结膜血流速度增加,配戴者的主观不适症状与球结膜血流速度呈正相关.