非侵入性泪膜功能检查在干眼诊断中的初步应用

Application of noninvasive tear film function examinations on dry eye diagnosis

目的采用Oculus四代角膜地形图仪分析干眼患者泪膜功能及首发破裂部位的分布情况。设计前瞻性比较性病例系列。研究对象2013年7-9月在北京同仁眼科中心就诊的干眼患者51例（51眼）及对照组86例（86眼）。方法对受检者进行眼表疾病评分指数（Ocular Surface Disease Index,OSDI）问卷调查,使用Oculus四代角膜地形图仪进行非侵入性泪膜破裂时间（noninvasive tear breakup time,NITBUT）及泪河高度（tear meniscus height,TMH）测定。分析干眼组及对照组OSDI评分、首发泪膜破裂时间（the first NITBUT,NITBUTf）、平均泪膜破裂时间（the average NITBUT,NITBUTav）及泪河高度差异及各项指标之间的相关性。以角膜中心点为圆心,1 mm间距将角膜划分为1～8环,并以横、纵坐标为界划分为四个象限,这样将角膜划分为29个区域。分析每位受检者首次泪膜破裂的部位,并比较分析两组受检者组间差异。主要指标OSDI评分、NITBUTf、NITBUTav、泪河高度及泪膜破裂首发部位。结果干眼组与对照组OSDI分值、NITBUTf及NITBUTav分别为（31.41±14.20）分和（4.80±7.40）分,（3.99±0.61）s和（8.90±3.51）s,（7.54±3.11）s和（11.76±4.30）s（P=0.000,0.000,0.016）,两组泪河高度分别为（0.22±0.098）mm和（0.25±0.096）mm（P=0.217）。OSDI评分与NITBUTf、NITBUTav呈线性负相关（r=-0.760、-0.490,P均=0.000）,NITBUTf与NITBUTav呈线性正相关（r=0.671,P=0.000）,泪河高度与OSDI评分、NITBUTf、NITBUTav均无相关性（P均〉0.05）。干眼组及对照组泪膜破裂首发部位主要分布在2~5环（分别占73.08%、75.42%）;泪膜破裂首发部位在不同环间出现的概率,两组受试者均具有统计学意义（χ2=13.897、30.017,P=0.031、0.000）。以四个象限为分区单位,干眼组及对照组泪膜破裂首发部位出现概率均无统计学意义（χ2=2.103、5.186,P=0.551、0.159）。结论 Oculus四代角膜地形图仪能客观地检查泪膜破裂时间及破裂部位;泪膜破裂时间与患者主诉症状即OSDI评分具有较显著的线性负相关;干眼患者泪膜破裂首发部位以瞳孔区角膜处发生的概率最高。

Objective To analyze tear film function and the location of first breakup point in dry eye patients using Oculus Ker- atograph. Design Prospective comparative case series. Participants Fifty-one patients with dry eye and eighty-six healthy age- and sex-matched control subjects were included from July to September 2013. Methods The dry eye symptoms in all subjects were evaluat- ed with the Ocular Surface Disease Index （OSDI） questionnaire. Noninvasive tear breakup time （NITBUT） and tear meniscus height （TMH） were tested with Oeulus Keratograph. One eye of each subject was included in the study. Differences of OSDI scores, first NIT- BUT （NITBUTf）, average NITBUT （NITBUTav） and TMH between dry eye group and control group were compared. The correlations of these parameters were assessed. Locations of first tear film breakup point were observed and differences between two groups were ana- lyzed. Main Outcome Measures OSDI scores, NITBUTs NITBUTav, TMH and first tear film breakup point location. Results Differ- ences of OSDI scores, NITBUTf, NITBUTav between dry eye group and control group were significant （P=0.000, 0.000, 0.016, respec- tively）. No significant difference of TMH between two groups was found （P=0.217）. There were linear negative correlations betweenNITBUTr, NITBUTav and OSDI scores （r=-0.760, -0.490, respectively; P=0.000）. Linear positive correlation was found between NITBUTf and NITBUTav （r=0.671 ,P=0.000）. There was no correlation between OSDI scores, NITBUTf, NITBUTav and TMH（r=-0.099,0.116, 0.019; P=0.252, 0.178, 0.824, respectively）. The oceurrence of first tear fihn breakup point of dry eye group and control group was mainly emerged in loop 2 to 5 （73.08% and 75.42%, respectively）. The occurrence has significant difference among different loops in both groups （X2=13.897, 30.017; P=0.031, 0.000, respectively）. There was no significant difference between different quadrants in both groups （X2=2.103, 5.186; P=-0.551, 0.159, respectively）. Conclusion Oculus Keratograph could be used to analyze noninvasive tear film function. NITBUT was related to the OSDI. It showed that the first tear film breakup point of dry eye patients occur-red in the pupil areaof cornea most frequently.