干眼患者临床表现及视功能的日间波动

Diurnal fluctuation of clinical manifestation and visual function in dry eye patients

目的评估几种不同类型的干眼患者临床表现及视功能的日间波动。方法 对就诊于我院门诊的45例(90眼)干眼患者(Sj gren综合征组13例,非Sj gren综合征组18例,睑板腺功能障碍组14例)行干眼相关临床检查,包括最佳矫正视力、泪膜破裂时间、基础泪液分泌试验、改良的眼表疾病指数问卷调查以及瞬目间期视力衰退(interblink interval visual acuity decay,IVAD)、功能性瞬目间期(functional interblink interval,FII)检查。所有患者均在上、下午进行2次检查。另设正常对照组10例,行IVAD、FII检查。对检查结果进行统计学分析。结果 正常对照组FII、IVAD检查结果分别为(23.22±2.10)s、(12.12±1.91)s,较3组干眼患者明显延长,差异均有显著统计学意义(均为P<0.001)。不同分组和不同时间点检测的最佳矫正视力差异均无统计学意义(均为P>0.05),而不同分组和不同时间点检测的泪膜破裂时间、基础泪液分泌试验、眼表疾病指数、FII以及IVAD差异均有统计学意义(均为P<0.05);干眼患者临床表现及视功能存在日间波动,下午较上午症状严重。临床表现以Sj gren综合征组最重,睑板腺功能障碍组次之,非Sj gren综合征组最轻。结论 干眼患者的临床表现和视功能存在日间波动现象。IVAD检查作为一种新的干眼检查方法,能够从视功能角度对干眼患者进行评估,具有一定的临床应用价值。

Objective To evaluate diurnal fluctuation of clinical manifestation and visual function among several kinds of dry eye patients. Methods Dry eye examinations, including best corrected visual acuity （ BCVA）, break-up time （ BUT ）, Shirmer I test, ocular surface disease index （OSDI）, interblink interval visual acuity decay （WAD） and functional interblink interval（FII） were performed among 45 dry eye patients （ 13 Sj6gren syndrome,18 non-Sjogren syndrome,and 14 meibomian glands deficiency）. All patients were underwent examinations twice a day. WAD tests were also performed among l0 normal people,serving as the control group. The results were statistically analyzed. Results The mean value of FII, WAD tests in the control group were （23.00 ± 2.10）s and （12. 12 ± 1.91 ）s, which were significantly longer than the three dry eye groups（ all P 〈 0. 001 ）. There is no significant difference in BCVA among different groups and among different time points（ all P 〉 0.05 ）. However, significances were noticed in BUT, Shirmer I tests, OSDI, FII and WAD among different groups and different time points （ all P 〈 0.05 ）. Diurnal fluctuation of these measurements was noticed among dry eye patients and more severe in the morning than at afternoon. The most severe clinical manifestations were noticed in Sjogren syndrome group, moderate in meibomian glands deficiency, and mild in the non-Sjogren syndrome group. Conclusions Diurnal fluctuation of clinical manifestation and visual function exist in dry eye patients. WAD test,a new dry eye examination,may remain clinical value and shed light on evaluating dry eye patients from visual function aspect.