角膜激光共聚焦显微镜联合眼表综合分析仪在蠕形螨感染所致眼表疾病诊治中的应用

Clinical application of the Keratograph 5M and in vivo confocal microscopy in the ocular disease induced by Demodex infection

目的:探讨角膜激光共聚焦显微镜联合眼表综合分析仪辅助诊断蠕形螨感染所致相关眼表疾病的临床应用价值。方法:收集眼科门诊眼表疾病患者194例,采用角膜激光共焦显微镜进行眼部蠕形螨感染的检查,对蠕形螨感染阳性患者(121例)以Oculus Keratograph 5M眼表综合分析仪检测非侵入性首次泪膜破裂时间(NITBUTf)、非侵入性平均泪膜破裂时间(NITBUTav)、下泪河高度(LTHM),并对睑板腺缺失进行评分。结果:睑缘炎患者(126例)中蠕形螨感染阳性率(85. 7%)明显高于非睑缘炎患者(68例)中蠕形螨感染阳性率(19. 1%);经眼表综合分析仪检查确诊蠕形螨感染的睑缘炎患者中同时伴有干眼患者89例(82. 4%),睑板腺功能障碍患者86例(79. 6%),蠕形螨感染的非睑缘炎患者中经眼表综合分析仪检查确诊同时伴有干眼患者3例(23. 1%),睑板腺功能障碍患者2例(15. 4%),蠕形螨感染的睑缘炎组干眼及睑板腺功能障碍发生率均高于非睑缘炎组(P<0. 05)。结论:角膜激光共焦显微镜联合眼表综合分析仪能显著提高蠕形螨性睑缘炎诊断准确率,并可对蠕形螨感染所致的眼表损害进行综合评价,指导临床精准治疗,减少相关并发症的发生。

Objective:To explore the clinical application of in vivo confocal microscopy combined with ocular surface analyzer in the related ocular surface diseases caused by Demodex infection.Methods:194 patients with ocular surface diseases in ophthalmology clinics were examined by the in vivo confocal microscope.In addition,Patients with positive Demodex infection(121 cases)underwent Oculus Keratograph 5 M to detect the non-invasive first tear break-up time(NITBUTf),average non-invasive tear break-up time(NITBUTav),and lower tear height(LTHM),and the meibomian gland loss score was calculated.Results:Demodex infection was found in 108 patients(85.7%)with blepharitis and in 13 patients(19.1%)of non-blepharitis group.The difference between the two groups was statistically significant.108 patients with blepharitis infected by Demodex were diagnosed by ocular surface com-prehensive analyzer and 89 patients(82.4%)were combined with dry eye,86 patients(79.6%)with meibomian gland dysfunction;of the patients with non-blepharitis,13 patients were combined with Demodex,3 patients(23.1%)with dry eye and 2 patients with meibomian gland dysfunction(15.4%).The incidence of dry eye and meibomian gland dysfunction in patients with Demodex infection was higher than that in patients without Demodex infection.There was a statistically significant difference in the incidence of dry eye and meibomian gland dysfunction between the two groups.Conclusion:The in vivo confocal microscopy combined with Oculus Keratograph 5 M can significantly improve the diagnostic accuracy of Demodex blepharitis,and comprehensively evaluate the ocular surface damage caused by Demodex infection.It helps to guide clinical precision treatment and reduce related complications.