眼下穹隆结膜囊气泡与干眼的关系

Clinical evaluation of relationship between dry eye and bubbles in the inferior conjunctiva fornix

背景泪膜不稳定伴随眼表温度升高及泪液蒸发增强均是眼表气泡产生和干眼发病的相关因素，但眼表气泡与干眼发病的关系尚缺少相关研究。眼表气泡在相对密闭的穹隆部结膜囊内存留时间长，在下穹隆结膜囊检查更方便。目的探讨眼下穹隆结膜囊气泡与干眼的关系。方法收集2012年1-5月于武汉科技大学附属天佑医院眼科门诊就诊的有多种眼表刺激症状且双眼下穹隆结膜囊有气泡者（气泡组）和双眼下穹隆结膜囊无气泡者（无气泡组）各32例64眼，两组患者的年龄及性别相匹配。患者在裂隙灯显微镜下进行下穹隆部气泡检查，所有患者均行泪膜破裂时间（BUT）和泪液分泌试验I（SIt）检查，干眼的诊断参照刘祖国等的标准。两组患者BUT、SIt检查结果的差异比较采用独立样本t检验，两组患者干眼发生率的比较采用z。检验。结果气泡组64眼中干眼发生率为75．00％，BUT〈5s且SIt〈5ram／5min的发生率为46．88％，仅BUT〈5S的发生率为53．13％，仅SIt〈5mm／5min的发生率为57．81％；无气泡组64眼中干眼的发生率为31．25％，BUT〈5S且SIt〈5mm／5min的发生率为18．75％，仅BUT〈5S的发生率为21．88％，仅sIt〈5mm／5rain的发生率为20．31％，两组间差异均有统计学意义（均P=0．00）。诊断为干眼的68眼中，气泡组48眼，占70．59％（48／68）；无气泡组20眼，占29．41％（20／68），二者间差异有统计学意义（X2=24．60，P〈0．01）；气泡组与无气泡组患者BUT〈5s的发生率、SIt〈5mm／5min发生率的差异均无统计学意义（矿=0．01，P=0．95；X2=1．06，P=0．30）。2个组间患者BUT检测值及SIt检测值的比较差异均无统计学意义（t=0．46，P=0．65；t=0．80，P=0．43）。结论干眼与眼下穹隆结膜囊气泡有显著的相关性。

Background Instability of tear film,increase of ocular surface temperature and tear evaporation are the associated factors of both bubbles and dry eye. But the relationship between dry eye and ocular surface bubbles is unclear. The bubbles are easily retained and checked in the inferior conjunctiva fornix. Objective This study aimed to study the relationship between dry eye and bubbles in the inferior conjunctiva fornix. Methods Sixty-four eyes of 32 patients with binocular irritative symptoms and bubbles or without bubbles in the inferior conjunctiva fornix were collected in Affiliated Tianyou Hospital of Wuhan University of Science and Technology from January to May, 2012. The bubbles in the inferior conjunctiva fornix were examined by slit lamp microscope,and the break-up time （BUT） and Schirmer I test （S I t） were performed. The differences of BUT and S I t between the two groups were compared using independent sample t test, and abnormality rate of examination indexes was statistical analyzed by CHI-Square test using a SPSS 11.5 software. Written informed consent was obtained prior to the clinical survey. Results In the 64 eyes of the bubbles group,incidence of dry eye was 75.00% ,and the incidence of both BUT〈5 seconds and S I t〈5 mm/5 minutes was 46.88% ;while the incidence of BUT〈5 seconds or S I t〈5 mm/5 minutes was 53. 13% and 57.81% ,respectively. In 64 eyes without bubbles,incidence of dry eye was 31.25% ,the incidence of both BUT〈5 seconds and S I t〈5 mm/5 minutes was 18.75% ,that of BUT〈5 seconds or S [ t〈5 mm/5 minutes was 21.88% and 20.31% , respectively. The incidences of dry eye, both BUT〈5 seconds and S I t〈5 ram/5 minutes, BUT 〈5 seconds,S I t〈5 mm/5 minutes were significantly higher in the bubbles group than those of the without bubbles group （all at P=0. 00）. In the 68 eyes determined as dry eyes,48 eyes （48/68） were in the bubbles group and 20 eyes （20/68） were in the without bubbles group, showing a significant difference between the two groups （X2= 24.60,P〈0.01 ）. The incidences of both BUT〈5 seconds, S I t〈5 ram/5 minutes were not significantly different between the two groups （X2 = 0. 01, P = 0. 95 ;X2 = 1.06, P = 0.30 ）. Conclusions The bubbles in the inferior eonjunctiva fornix is highly correlated with dry eye.