非侵入式眼表综合分析仪评估近视青少年干眼和睑板腺功能障碍

Evaluation of dry eye and meibomian gland dysfunction in myopic teenagers by noninvasive keratograph

目的通过问卷调查和临床检查分析青少年近视患者干眼和眼表状况。方法选取248例（496眼）7~18岁近视青少年患者为研究对象,进行眼表疾病指数（ocular sur-face disease index,OSDI）问卷调查,裂隙灯下行眼前节检查,格瓦拉-眼表综合分析仪Keratograph 5M检查眼表。根据OSDI干眼分级标准将患者分为干眼组（47例94眼）和正常组（201例402眼）,分别对两组的眼表和睑板腺状况进行评估与比较。结果近视儿童干眼发病率为18.95%。干眼组泪河高度为（0.23±0.03）mm,正常组为（0.22±0.03）mm,两组泪河高度均在正常范围内（泪河高度〉0.20 mm）。干眼组和正常组的OSDI值分别为（27.02±14.35）分、（7.29±3.36）分,角膜荧光素染色评分分别为（3.51±1.67）分、（1.23±2.32）分,这两项指标在干眼组均明显高于正常组（P〈0.001）,NIBUT小于正常组（P〈0.001）。干眼组中睑板腺开口状况评分、睑板腺脂质分泌物性状评分、睑板腺缺失评分均明显高于正常组（均为P〈0.000 1）,纳入的248例近视青少年的睑板腺参数与角膜荧光素染色评分有正相关性（P〈0.000 1）,与非侵入性泪膜破裂时间有负相关性（P〈0.05）,但与泪河高度无相关性（P〉0.05）,OSDI值与非侵入性泪膜破裂时间呈负相关（rs=-0.982,P=0.000）,与睑板腺的缺失评分呈正相关（rs=0.838,P=0.000）。结论睑板腺功能障碍是近视青少年人群干眼的重要病因之一,Keratograph 5M非侵入式眼表综合分析仪可无创性客观评价近视青少年患者眼表的情况。

Objective To evaluate dry eye and the ocular surface condition of myopic teenagers with a questionnaire and clinical examinations.Methods A total of 496 eyes from 248 myopic teenagers（7-18 years old） were examined.The ocular surface disease index（OSDI）questionnaire,slit lamp examination and Keratograph 5M were administered.Patients were then divided into two groups according to OSDI score：Dry eye group（47 patients,94 eyes） and normal group（201 patients,402 eyes）,then the ocular surface and meibomian gland condition were compared and evaluated.Results The prevalence of dry eye in myopic teenagers is 18.95%.The tear meniscus height in the dry eye group and normal group were（0.23 ± 0.03） mm and（0.22 ±0.03） mm,respectively,both were in normal range（〉0.20 mm）.OSDI in the dry eye group and normal group were 27.02 ±14.35,7.29 ± 3.36,and corneal fluoresce scores were3.51 ± 1.67,7.29 ± 3.36,respectively.The two indexes were significantly higher in the dry eye group than the normal group（all P〈0.001）,and the noninvasive break-up time（NIBUT） in the dry eye group was smaller than that in the normal group（P〈0.001）.All three meibomian gland dysfunction parameters（meibomian gland orifice scores,meibomian gland secretion scores,meibomian gland dropout scores） of the dry eye group were significantly higher than those of the normal group（all P〈0.0001）.The meibomian gland dysfunction parameters of 248 myopic teenagers were positively correlated with corneal fluoresce scores（P〈0.000 1） and negatively correlated with NIBUT（P〈0.05）,but had no correlation with tear meniscus height（P〉0.05）.Negative correlation was found between NIBUT and OSDI（rs =-0.982,P =0.000） and positive correlation was found between meibomian gland dropout scores and OSDI in the two groups（rs =0.838,P =0.000）.Conclusion Meibomian gland dysfunction plays an important role in the mechanism of dry eye.The Keratograph 5M appears to provide an effective noninvasive method for assessing myopic teenagers＇ ocular surface situation.