眼球表面生理評估及探討: (1).以生物模式認證硬式高透氧隱形眼鏡之護眼功效 (2).探討眼用凝膠緩解乾眼症影響之視覺功能分析

(1).The biological protective effects of UVB-blocking RGP in vivo (2).Visual function assessment following amelioration of dry eye symptoms with dry eye gel

周宣任(Hsuan-Jen Chou)

指導教授 ： 陳伯易 ； 蕭清仁

中山醫學大學/醫學科技學院/生物醫學科學學系碩士班/碩士(2013年)

摘要

(1)摘要
紫外線(UV)可能造成眼睛多種疾病，特別是長時間照射波長為312nm的短波長紫外線-B(UV-B)。過去的研究大多探討軟式隱形抗UV-B的保護效應，但在生物體的模式，較少評估硬式高透氧隱形眼鏡 (R.G.P.)抗UV-B的防護效應。
　　本篇研究探討R.G.P.在UV-B照射下護眼的持續性及可靠性。實驗使用ICR小鼠，隨機分成四組：[第1組]沒有UV-B照射之空白對照組、[第2組]UV-B照射組、[第3組] UV-B照射+TMVC RGP組和[第4組] UV-B照射+Sinsaki RGP組。[第3組]和[第4組]組小鼠皮下注射麻醉藥物後個別覆蓋上TMVC RGP及Sinsaki RGP，並每天照射UV-B持續5天。UV-B照射後會導致角膜上皮損傷，角膜平滑度、清澈度降低，以及影響角膜敏感度和視敏度。在組織分析中，可觀察出角膜上皮厚度降低，p63+基礎細胞減少；在免疫染色分析顯示，改變了Cox-2, NF-κB, Fas, MMP-9和Cytokeratin-5的表現。TMVC或Sinsaki RGP可以保護受UV-B照射之組織及細胞，以改變組織傷害及細胞發炎指標。
本篇研究結論，藉由小鼠為生物模式，證明RGP能有效抗UV-B，在生物上達到防護效應。
(2)摘要
「乾眼症」是眼科門診常見的疾病之一，人工淚液為乾眼症第一線治療藥物，人工淚液依照黏稠度分成眼用藥水、眼用凝膠及眼用藥膏。全民健保給藥制度需有基礎淚液檢查(Schirmer' s test)記錄，過去文獻指出，沒有單一項特定檢查可以特異地確診乾眼症。本篇實驗動機為探討眼用凝膠的治療效應，主觀及客觀綜合分級評估乾眼臨床指標。受試者為經眼科醫生評估的乾眼症患者，實驗隨機分成兩組：[第1組]有眼用凝膠組，[第2組]無眼用凝膠對照組，治療為期1個月± 1星期，在治療前後進行主客觀評估，主觀評估包含主觀評估量表，客觀評估包含角結膜螢光染色、淚液稜鏡高度、瞼板腺功能檢查、修門氏檢查。實驗結果發現，兩組治療後在主觀評估問卷的表現皆有改善乾眼症狀，其中[第1組]較高的表現量。客觀綜合分級評估的表現中，85%的族群治療後降低乾眼臨床徵兆，其中59%為[第1組]占較高的比率；10%的族群治療後提高乾眼臨床徵兆，其中71%為[第2組]占較高的比率。
結論證實，眼用凝膠治療能顯著降低乾眼症臨床徵兆及病人主觀乾眼症狀。

關鍵字

紫外線-B ； 硬式高透氧隱形眼鏡 ； 生物防護 ； 乾眼症 ； 人工淚液 ； 眼用凝膠

並列摘要

(1) abstract
UV irradiation may cause a variety of ocular diseases. Particularly, the short wave UV at 312 nm wavelength inflicts most on corneal health after long term exposure. Previous animal studies have been focused on the protective effects by soft contact lenses and relatively few evaluations on rigid gas-permeable (RGP) lenses were reported.
　　This study investigated the persistence and reliability of RGP under the influence of UVB. ICR mice were randomly divided into 4 groups: (1) blank control without UVB exposure, (2) with UVB exposure, (3) with UVB exposure, and with TMVC RGP, and (4) with UVB exposure, and with Sinsaki RGP. Following anesthesia, the mice of groups (3) and (4) were covered with RGP lenses and exposed to daily UVB for a 5-day period.
　　UVB exposure lead to corneal surface damages, including reduced smoothness and transparency, impaired cornea sensitivity and visual acuity. Histological analysis revealed that corneal thickness was decreased and fewer p63+ basal cells were observed. Immunohistochemistry assay showed alterations of Cox-2, NF-κB, Fas, MMP-9 and Cytokeratin-5 expression. With TMVC or Sinsaki RGP lenses to shield UVB irradiation, the tissues damages and the alterations of cellular and inflammatory markers were all ameliorated. This study demonstrated the bio-protective effects of RGP by using mouse as a study model for the assessment of UV shield efficacy.
(2) abstract
　Dry eye is a very common clinical disease in clinical ophthalmology practice. Artificial tear formulas in tincture, gel, and ointment forms are prescribed for the relief of dry eye symptoms. National Health Insurance pay off the prescriptions based on basic tear assessment data, such as the results from repetitive Schirmer' s tests. However, previous literature indicated that no single test can be used for final confirmation of dry eye diagnosis.
　　This study aimed to examine the relief effects of ophthalmological gel therapy by subjective and objective assessments. The volunteers were recruited according to clinical ophthalmological criteria. They were then randomly allocated into either the experimental group (with gel) or the control group (without gel). The treatment session was 1 month±1week. Subjective and objective assessments were applied before and after the treatment. The subjective assessment included a standard questionnaire. The objective assessments include fluorescin stain, tear meniscus height, meibomian gland function test, and Schirmer’s test. The results showed that both groups, with or without ophthalmological gels, had better subjective response after treatment. Those with gel showed better response than those without gel. Overall, 85% of volunteers showed improved clinical symptoms after treatment. Among them, 59% was on gel prescription, higher than the remaining 41% who were treated without gel prescription. There were 10% of volunteers who showed more severe dry eye symptoms after treatment and 71% among them were treated without gel prescription.
　　In conclusion, the use of ophthalmological gel is effective for the relief of both subjective and objective dry eye symptoms.

並列關鍵字

UVB ； RGP ； Bioprotection ； dry eyeness ； artificial tear ； ophthalmological gel

參考文獻

(1) References

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