Topographic tear film trend and new parameters for noninvasive break up time test

AIM:To evaluate the quantitative and qualitative results of the noninvasive tear film break-up time(NI-BUT)test and investigate the predictive ability of the new NIBUT parameter in discriminating between normal Ocular Surface Disease Index(OSDI;scores≤12)and abnormal OSDI(scores≥13).METHODS:A total of 341 eyes of 341 volunteers who applied for routine eye outpatient control were included in the prospective study.All participants'noninvasive first tear film break-up time(NIF-BUT),noninvasive average tear film break-up time(NIAvg-BUT)and average value of the first three break-up time(A3F-BUT)were analyzed.A3F-BUT,the new NI-BUT parameter,is calculated by adding the NIF-BUT value to the 2^(nd )break-up time value that has a difference of at most 1 second from the NIF-BUT value and to the 3^(rd) break-up time and then dividing the respective sum by 3.Receiver operating characteristic(ROC)curve and forward logistic regression analyses were performed to determine the parameter that had the best predictive ability between the OSDI groups.RESULTS:The NI-BUT values of 255 eyes of 255 volunteers included in the study were analyzed statistically.The mean NIF-BUT,NIAvg-BUT,and A3F-BUT values were calculated as 5.3±3.0,8±3.1,and 5.8±3.0 seconds,respectively.All three parameters were found to be significantly lower in the abnormal OSDI group(P=0.014,0.034,and 0.011,respectively).The area under the curve(AUC)of the A3F-BUT to predict abnormal OSDI was AUC=0.625(0.529-0.720),P=0.011 and NIF-BUT was AUC=0.599(0.502-0.696),P=0.043.The A3F-BUT parameter and NIF-BUT parameters were found to be significantly efficient in discriminating abnormal OSDI.CONCLUSION:The new parameter for the NI-BUT test has more predictive ability in the discrimination of OSDI groups.

基于近红外图像处理的便携式干眼诊断仪研究

针对目前市面上的干眼诊断设备有诸如成本高、体积大和由于使用帧差法导致检测结果准确度不高等一些问题,本文设计了基于近红外图像诊断干眼的便携式设备。该设备使用基于近红外成像的Windows计算机进行检测,便于携带,可用于检测泪膜破裂时间(tear film break-up time,TBUT)、睑板腺(meibomian gland,MG)与泪河高度(tear meniscus height,TMH)等干眼症状。采用分形盒维数法检测TBUT,避免帧差法检测不准确;通过近红外(850 nm)补光成像技术检测MG,采用对比度受限自适应直方图均衡(contrast-limited adaptive histogram equalization,CLAHE)算法处理,将腺体区域突出,能够更加准确地检测面积缺失率。为了验证该仪器检测结果准确性,使用50组测试样本进行验证性实验,实验结果与意大利的CSO Antares(安达斯)仪器和SBM公司的ICP OSA等的检测结果进行对比。该设备的TBUT和TMH检测的结果与两个对照组结果的相关系数为P<0.05,检测的结果一致性较好;MG的检测正确率为86%,特异度为84%。实验结果表明,该设备可作为干眼症的筛查和诊断设备用于眼科医院和视觉光学中心。

Keratograph眼表综合分析仪与传统方法对泪膜功能评价的一致性分析

目的:探讨一种最新的眼表综合分析仪Keratograph对于泪膜稳定性评估的重复性和准确性,将其测量值与传统的检查方法进行比较。方法:采用Keratograph测量包括首次泪膜破裂时间(the first tear film break-up time,BUT-f)和平均泪膜破裂时间(the average tear film break-up time,BUT-ave)在内的非侵入式泪膜破裂时间(noninvasive tear film break-up time,NI_BUT)结果。测量结果的重复性使用变异系数(coefficient of variation,CV)和组内相关系数(intraclass correlation coefficient,ICC)进行评价,NI-BUT与传统的荧光素泪膜破裂时间(fluorescein tear film break-up time,FBUT)的比较采用Wilcoxon符号秩和检验,确定NI-BUT与FBUT,SchirmerⅠ试验结果的相关关系,采用BlandAltman分析进行一致性评价。结果:本研究纳入了48个受检者(48眼),平均年龄38.7±15.2岁。BUT-f的CV和ICC分别为12.6%和0.95,BUT-ave的为9.8%和0.96。BUT-f值低于FBUT值,差异有统计学意义(6.16±2.46s vs 7.46±1.92s,P<0.01)。NI-BUT与FBUT,SchirmerⅠ试验结果之间存在显著的正相关关系(P<0.01)。BUT-f与FBUT的95%一致性界限(limits of agreement,Lo A)范围为4.46s,BUT-ave与FBUT的Lo A范围为3.64s。结论:Keratograph能够提供具有较好重复性和可靠性的NI-BUT数据,在干眼诊治和角膜屈光性手术等领域有很好的应用前景。

斜视术后的眼表评价

目的:探讨斜视手术后患者的眼表情况。方法:选取2015-05/2016-10我院住院治疗的斜视患者188例240眼,按手术切口不同分为3组:A组85例100眼行角膜缘切口;B组35例50眼行跨肌止端切口;C组68例90眼行近穹窿切口(包括Parks切口及改良的Parks切口)。行单条眼外肌手术者75眼,行2条眼外肌手术者110眼,行3条眼外肌手术者55眼。采用眼表综合分析仪分别于术前1d,术后1d,1、2、4wk检测非侵入性首次泪膜破裂时间(first noninvasive Keratograph tear breakup time,NIKBUTf)和泪河高度(tear meniscus height,TMH)并进行统计分析。结果:与术前1d比较,各不同切口组术后1d TMH均明显增高,NIKBUTf均明显缩短,差异均有统计学意义(P<0.05)。A组术后2wk时NIKBUTf恢复至术前水平,B、C组术后1wk时恢复至术前水平。A、B组术后2wk时TMH恢复至术前水平,C组术后1wk时恢复至术前水平。单条肌肉眼外肌手术者术后1wk TMH和NIKBUTf恢复至术前1d水平,行2条和3条肌肉手术者术后2wk时各指标恢复至术前水平。结论:手术切口选择和手术累及的肌肉条数都会影响斜视患者术后眼表健康情况;选择近穹窿切口行斜视手术恢复较快;斜视手术中所累积肌肉数越少,对眼表的影响越小。

妊娠期糖尿病患者眼表相关指标的临床分析

目的:应用Keratogragh 5M眼表分析仪对比妊娠期糖尿病孕妇与正常孕妇眼表相关指标。方法:选择妊娠期糖尿病患者45例45眼及正常孕妇48例48眼作为研究对象。所有对象完成眼表疾病指数(OSDI)问卷调查对眼表进行评分,应用Keratogragh 5M测量泪河高度(TMH)、非侵入性平均泪膜破裂时间(NIKBUTav)、眼红指数、睑板腺缺失评分。得出结果后对两组各项指标进行比较。结果:妊娠期糖尿病组及正常孕妇组的OSDI、TMH、NIKBUTav、眼红指数及睑板腺缺失评分均无差异(P>0.05)。其中OSDI分别为8.02±4.25、7.50±4.28分(P=0.557),TMH值分别为0.22±0.05、0.20±0.04mm(P=0.158),NIKBUTav值分别为8.01±2.15、8.02±1.53s(P=0.971)。结论:妊娠期糖尿病组与正常孕妇组眼表各项指标差异均无统计学意义,妊娠期糖尿病对眼表相关指标没有明显的影响,可能与血糖控制良好有关。

Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy

AIM: To detect and analyze the changes on ocular surface and tear function in type II diabetic patients with proliferative diabetic retinopathy(PDR), an advanced stage of diabetic retinopathy(DR), using conventional ophthalmic tests and the high-resolution laser scanning confocal microscopy.METHODS: Fifty-eight patients with type II diabetes were selected. Based on the diagnostic criteria and stage classification of DR, the patients were divided into the non-DR(NDR) group and the PDR group. Thirty-six patients with cataract but no other ocular and systemic disease were included as non-diabetic controls. All the patients were subjected to the conventional clinical tests of corneal sensitivity, Schirmer I test, and corneal fluorescein staining. The non-invasive tear film break-up time(NIBUT) and tear interferometry were conducted by a Tearscope Plus. The morphology of corneal epithelia and nerve fibers was examined using the high-resolution confocal microscopy.RESULTS: The NDR group exhibited significantly declined corneal sensitivity and Schirmer I test value, as compared to the non-diabetic controls(P 【0.001). The PDR group showed significantly reduced corneal sensitivity, Schirmer I test value, and NIBUT in comparison to the non-diabetic controls(P 【0.001).Corneal fluorescein staining revealed the progressively injured corneal epithelia in the PDR patients. Moreover,significant decrease in the corneal epithelial density andmorphological abnormalities in the corneal epithelia and nerve fibers were also observed in the PDR patients.CONCLUSION: Ocular surface changes, including blunted corneal sensitivity, reduced tear secretion, tear film dysfunction, progressive loss of corneal epithelia and degeneration of nerve fibers, are common in type II diabetic patients, particularly in the diabetic patients with PDR. The corneal sensitivity, fluorescein staining scores,and the density of corneal epithelial cells and nerve fibers in the diabetic patients correlate with the duration of diabetes. Therefore, ocular surface of the patients with PDR should be examined regularly by conventional approaches and confocal microscopy to facilitate early diagnosis and treatment of keratopathy.

Keratograph5M眼表综合分析仪对共同性水平斜视患者的眼表评价

目的评价共同性水平斜视人群的眼表健康状况，并探究相关影响因素。方法征集共同性水平斜视患者，采用新一代的Keratograph5M眼表综合分析仪检测患者双眼首次非侵入式测量泪膜破裂时间（NI-TBUT-f）、平均非侵入式测量泪膜破裂时间（NI-TBUT-ave）及泪河高度（TMH），采用相关统计分析方法比较不同斜视类型、眼别、性别对检测指标的影响，及各测指标间的差异及相关性。结果研究征集了年龄在8-58岁的共同性水平斜视患者118例（236只眼），检测结果为，TMH（O．16±0．05）mm、NI-BUT-f（9．70±6．13）s、NI-BUT-ave（11．85±5．94）s，它们存在明显的正相关性；NI-BUT-f明显短于NI-BUT-ave（P=0．00）；除外男性的泪河高度值比女性略低（P=0．02），斜视类型、眼别及性别对检测结果无明显影响；相比年长者，25岁及以下者的泪膜破裂时间明显缩短（P=0．00）。结论儿童及青少年的眼表健康情况令人堪忧，应引起临床工作者高度重视。

Oculus眼表综合分析仪在干眼诊断中的应用

目的探究Oculus眼表综合分析仪在干眼诊断临床应用中的重要作用。方法横断面研究。对2014年4～9月在南京医科大学附属眼科医院进行Oculus眼表综合分析仪检查的患者225例，男73例，女152例，年龄（39.2 ±21.1）岁。收集年龄、性别、非侵入检查第一次泪膜破裂时间（nonin-vasive first break-up time，NIKf-BUT）、平均泪膜破裂时间（noninvasive average break-up time，NIKav-BUT）、泪河高度，并进行了睑板腺拍摄、眼红分析、脂质层观察。将影响干眼的可能因素年龄、性别等分别与NIKf-BUT、NIKav-BUT进行相关性分析。结果在确诊的189例干眼患者中，性别与NIKf-BUT无相关性，统计值P =0.568；与NIKav-BUT无相关性（P =0.910）。年龄与NIKf-BUT呈负相关（P=0.000），直线回归方程为为=11.145-0.068X。年龄与NIKav-BUT呈负相关（P=0.000），直线回归方程为=14.460-0.070X。36例水液缺乏型干眼患者年龄与NIKf-BUT无相关性（P=0.964）；与NIKav-BUT无相关性（P=0.702）。87例蒸发过强型干眼患者年龄与NIKf-BUT呈负相关（P =0.001）；与NIKav-BUT呈负相关（P=0.003）。66例混合型的干眼患者年龄与NIKf-BUT呈负相关（P=0.004）；与NIKav-BUT呈负相关（P=0.007）。结论结果显示性别不是干眼的影响因素，年龄是干眼的重要影响因素，尤其蒸发过强型干眼与年龄密切相关。Oculus眼表综合分析仪不仅可以诊断干眼，还可以分辨干眼类型，为干眼的对症治疗提供了临床依据。