目的:通过观察长期应用抗青光眼滴眼剂作用后结膜炎症反应的发生和炎性标记物ICAM-1在眼部的表达,探讨长期应用抗青光眼滴眼剂对结膜反应的影响。方法:从我科收住的原发性开角型青光眼患者90例,分为三组:应用5g/L噻吗洛尔与2g/L阿法根(联合用药组)30例;应用5g/L噻吗洛尔(单一用药组)30例;未用药组30例;单纯白内障患者作为空白对照组30例。按抗青光眼药物治疗时间及白内障患病时间分为三个时相(0～6mo,7～12mo,13～18mo)组,各个时相组10例,进行结膜上皮组织形态学观察及检测结膜上皮组织中ICAM-1炎性标记物的表达。结果:单一用药组在用药13～18mo时其球结膜组织学改变明显,表现为上皮形态不规则,表面不平或有上皮分离或增生,球结膜下纤维结缔组织排列不规则,小血管增多,巨噬细胞、淋巴细胞、成纤维细胞数增多。联合用药组在用药13～18mo时球结膜有明显的组织学改变,上皮有不同程度的增生或鳞状化生,上皮厚薄不均,表面不光滑,有上皮脱落,球结膜下组织中小血管增多,巨噬细胞、淋巴细胞、成纤维细胞数目明显增多、杯状细胞减少。单一用药组与联合用药组在13～18mo结膜组上皮组织中含ICAM-1抗原的阳性细胞数与其他组差别有统计学意义(P<0.01)。结论:长期联合应用抗青光眼药物可致结膜组织的炎性反应,结膜上皮组织中的炎性标记物ICAM-1表达明显增加。

AIM: To observe conjunctival inflammatory reaction and expression of inflammatory marker ICAM-1 after long time treatment with anti-glaucoma eyedrops,and to investigate the impact on conjunctiva.METHODS: Ninety primary open-angle glaucoma patients were collected.All patients were divided into three groups in accordance with the type of treatment by using the anti-glaucoma drug: combined medication group of 30 cases,single drug treatment group of 30 cases;non-drug group of 30 cases.30 cases with simple cataract acted as blank control group.Each group was divided into 3 time phrase(0-6,7-12,13-18 months)sub-groups by anti-glaucoma drug treatment time and cataract sick time,to conduct optical microscopy observation on conjunctival epithelial histomorphology and detect ICAM-1 expression.RESULTS: Single drug treatment group in applying drugs for 13-18 months had obvious bulbar conjunctival histology changes featured by its bulbar conjunctival epithelial tissue thickening,irregular shape,macrophages,lymphocytes,fibroblasts increase and irregular subconjunctival fibrous connective tissue.Combined medication group in applying drugs for 13-18 months had obvious bulbar conjunctival histology changes featured by the bulbar conjunctival tissue with varying degrees of epithelial hyperplasia or metaplasia,uneven epithelial thickness,increased number of small blood vessels in subconjunctival tissue,and macrophages,lymphocytes,fibroblasts markedly increased,goblet cells decreased.In the 13-18 months time phrase,single drug treatment group and combined medication group,compared with the other groups in ICAM-1 positive cell number of conjunctival epithelial tissue,had statistically significant differences(P<0.01).CONCLUSION:The conjunctival tissue inflammatory response and conjunctival epithelial tissue’s inflammatory marker ICAM-1 expression increased significantly.

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中国新乡市科技局资助项目(No.08S022)