睑板腺功能障碍型和水液缺乏型干眼患者视觉质量比较

Evaluation of visual quality parameters changes in patients with meibornian gland dysfunction and aqueous deficient dry eye

目的:分析睑板腺功能障碍型干眼(MGD)和水液缺乏型干眼(ADDE)患者的像差和散射相关参数,评估两种干眼类型患者的视觉质量。方法:将2018-01/10在我院门诊就诊的MGD患者25例(MGD组),ADDE患者25例(ADDE组),同时期就诊的健康人25例(对照组)纳入此次研究。三组受试对象填写眼表疾病指数量表(OSDI),接受泪液相关检查:泪液分泌试验(SⅠt)、泪膜破裂时间(TBUT)、角膜荧光染色(FL)。使用iTrace分析仪记录三组受试对象的高阶像差(HO)、球差(SA)、彗差(CA)和三叶草差(TA)的均方根值(RMS)。利用双通道视觉分析仪(OQASⅡ)记录三组受试对象自然状态下的散射值,包括调制传递函数截止频率(MTF cutoff)、斯特列尔比(SR)、客观散射指数(OSI),以及持续睁眼状态下OSI动态变化值(OSI均值)。结果:MGD组的OSDI评分明显高于ADDE组(38.2±5.6 vs 32.2±7.2分,P<0.01)。ADDE组的SⅠt明显低于MGD组(1.98±0.92 vs 12.52±6.80mm/5min,P<0.001)。MGD组的TBUT和FL显著低于ADDE组(TBUT:3.27±1.91 vs 6.02±1.05s,FL:3.27±2.18 vs 6.23±2.19,均P<0.001)。MGD组和ADDE组的HO、CA、TA、SA的RMS值均显著高于对照组(均P<0.001)。MGD组和ADDE组的HO、CA、TA、SA均无显著性差异(HO:0.385±0.081 vs 0.344±0.092,CA:0.210±0.062 vs 0.175±0.075,TA:0.107±0.056 vs 0.086±0.042,SA:0.322±0.078 vs 0.273±0.097,HO:t=1.67,P>0.05;CA:t=1.80,P>0.05;TA:t=1.50,P>0.05;SA:t=1.97,P>0.05)。MGD和ADDE组之间的MTF cutoff、SR、OSI无差异(MTF cutoff:33.28±8.28 vs 37.12±9.53,SR:0.19±0.06 vs 0.22±0.08,OSI:1.30±0.32 vs 1.12±0.52,MTF cutoff:t=1.52,P>0.05;SR:t=1.50,P>0.05;OSI:t=1.47,P>0.05)。持续睁眼状态下MGD组的OSI均值明显高于ADDE组(2.386±0.118 vs 1.554±0.058,P<0.001)。结论:治疗干眼的同时需要关注改善患者的视觉质量,MGD患者的视觉质量影响比ADDE患者更加严重。泪膜动态状态下的OSI均值是评估干眼患者视觉质量的敏感指标。

AIM:To analyze ocular wavefront aberrations and scattering parameters changes in patients with meibornian gland dysfunction(MGD)and aqueous deficient dry eye(ADDE),and assess the visual quality of patients with two types of dry eye syndromes.METHODS:There were 25 patients with MGD,25 patients with ADDE and 25 healthy controls treated in our hospital from January to October 2018 were included in this study.Ocular surface disease index questionnaire(OSDI)and tear film correlation examination were performed in three groups.The tear film correlation examination included tear break-up time(TBUT),Schirmer test(SⅠt)and cornea fluorescein staining(FL).The root mean square of total high order aberration(HO),comatic aberration(CA),trefoil aberration(TA)and spherical aberration(SA)were recorded with i-Trace visual function analyzer.The scattering values were recorded by the double-pass Optical Quality Analysis System(OQASⅡ),including the modulation transfer function(MTF cutoff),Strehl ratio(SR)and objective scattering index(OSI).Three groups of subjects kept their eyes open for 20s,the mean value of OSI was recorded using OQASⅡtear film analysis program.RESULTS:The OSDI score in MGD group was significantly higher than that in ADDE group(38.2±5.6 vs 32.2±7.2,P<0.01).The SⅠT score in ADDE group was significantly lower than that in MGD group(1.98±0.92 vs 12.52±6.80mm/5min,P<0.001).The TBUT and FL staining score were lower in MGD group than those in ADDE group(TBUT:3.27±1.91 vs 6.02±1.05s,FL:3.27±2.18 vs 6.23±2.19,all P<0.001).There was no significant difference in HO,CA,TA and SA between MGD Group and ADDE group(HO:0.385±0.081 vs 0.344±0.092,CA:0.210±0.062 vs 0.175±0.075,TA:0.107±0.056 vs 0.086±0.042,SA:0.322±0.078 vs 0.273±0.097,HO:t=1.67,P>0.05;CA:t=1.80,P>0.05;TA:t=1.50,P>0.05;SA:t=1.97,P>0.05).There was no statistically significant differences between MGD group and ADDE group with the value of MTF cutoff,SR and OSI(MTF cutoff:33.28±8.28 vs 37.12±9.53,SR:0.19±0.06 vs 0.22±0.08,OSI:1.30±0.32 vs 1.12±0.52,MTF cutoff:t=1.52,P>0.05;SR:t=1.50,P>0.05;OSI:t=1.47,P>0.05).In the condition of not blinking,the mean value of OSI in MGD group was significantly higher than that in ADDE group(2.386±0.118 vs 1.554±0.058,P<0.001).CONCLUSION:In the treatment of symptoms of patients with dry eye,improving the visual quality of patients should also be considered.The visual quality in patients with MGD is more serious than those with ADDE.The OSI related parameters seem to be sensitive indicators indexes to evaluate the dynamic changes of tear film-related visual quality in dry eye patients.