前节OCT泪河测量的相关参数在干眼诊断中的应用研究

Application of OCT-RTVue for the diagnosis of dry eye

目的探讨前节相干光断层扫描(optical coherence tomography,OCT)测量泪河的相关参数与干眼诊断指标间的相关性,并对其在干眼诊断中的敏感性和特异性进行分析。设计前瞻性病例系列。研究对象2015年6-12月北京同仁眼科中心干眼患者69例(69眼)及对照组44例(44眼)。方法所有被检查者均按如下顺序进行检查:眼表疾病评分指数(ocular surface disease index,OSDI)问卷调查、泪河的OCT测量、泪膜干涉成像仪检查、泪膜破裂时间(BUT)测定、角结膜荧光素染色、基础泪液分泌试验(SchirmerⅠ)。比较干眼组与正常对照组各项参数的差异。干眼组中各参数相关性分析使用Spearman相关分析法,各参数敏感性及特异性采用受试者工作特征(ROC)曲线及ROC曲线下面积(AUC)来计算。主要指标OSDI评分、BUT、Schirmer I、角结膜染色评分、泪膜脂质层评分、泪河高度(tear meniscus height,TMH)、泪河深度(tear meniscus depth,TMD)及泪河横截面积(tear meniscus area,THA)。结果干眼组患者OSDI评分(49.03±22.791)、角结膜染色评分(1.18±1.84)明显高于对照组的(8.91±4.99)和(0.24±0.52)(P<0.001、P=0.016);干眼组患者BUT(4.32±1.92 s)及Schirmer I(4.29±3.77 mm)明显低于对照组的(7.43±5.39 s)及(7.48±3.65 mm)(P<0.001、P=0.006)。两组泪膜脂质层评分无明显统计学差异(P=0.158)。干眼组患者TMD、TMH、TMA平均值分别为(127.12±86.95)μm、(152.52±125.15)μm、(12119±1342)μm^2,均明显小于对照组的(188.25±87.38)μm、(235.41±135.90)μm、(23099±1965)μm^2(P<0.001、0.001、0.001)。干眼组TMD、TMH、TMA值三项参数分别与OSDI、Schirmer I、TBUT之间有相关性(P均<0.05),其诊断干眼的AUC值分别为0.934、0.890、0.925。结论前节OCT检测的泪河相关参数与干眼临床诊断的指标(OSDI、TBUT、Schirmer I)存在较好的相关性,是一种较为可靠的干眼诊断及随诊方法。

Objective To evaluate the detection of tear meniscus by OCT-RTVue and the relativity between the parameters of OCT-RTVue and the traditional diagnosis parameters in dry eye. Design Prospective case series. Participants Sixty-nine patients with dry eye and forty-four healthy age-and sex-matched control subjects were included from June to December 2015. Methods All subjects were underwent the examinations sequentially as follows： evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index（OSDI）, the examinations of OCT-RTVue, tear film interferometry, tear film break-up time（BUT）, corneal and conjunctival staining（Oxford scale） and Schirmer I test. The parameters between dry eye group and the control group were compared. Spearmans correlation analysis was used to analyze the correlation of the parameters of dry eye group. Receiver operating characteristic curve（ROC curve） and area under the curve（AUC） were used to describe the accuracy of each parameter to differentiate dry eyes from normal eyes.Main Outcome Measures OSDI score, BUT, Schirmer I, the score about lipid layer of the tear film, conjunctival staining, tear meniscus height（TMH）, tear meniscus depth（TMD）, tear meniscus area（THA）. Results OSDI score and conjunctival staining were obviously higher in dry eye group（49.03±22.791, 1.18±1.84） than those in control group（8.91±4.99, 0.24±0.52）（P〈0.001, 0.016）. BUT and Schirmer I value were significantly lower in dry eye group（4.32±1.92 s, 4.29±3.77 mm） than those in control group（7.43±5.39 s, 7.48 ±3.65mm）（P〈0.001, 0.006）. According to the score about lipid layer of the tear film, there wasn＇t significant differences in the two group（P=0.223）. TMD, TMH, TMA were significantly higher in dry eye group（127.12±86.95 μm, 152.52±125.15 μm, 12119 ± 1342 μm^2） than those in control group（188.25 ± 87.38 μm, 235.41±135.90 μm, 23099±1965 μm^2）（P〈0.001, 0.001, 0.001）. TMD, TMH, TMA were correlated with OSDI, Schirmer I, BUT in dry eye group（all P〈0.05）. AUC value of TMD, TMH, TMA was 0.934, 0.89, 0.925 respectively. Conclusion The examinations OCT-RTVue can reflect accurately the tear meniscus height and depth and may have potential applications for the diagnosis and evaluation of dry eye.