Association between tear film break up time and blink interval in visual display terminal users

AIM：To investigate the association between tear film break up time（TBUT）and blinking interval in visual display terminal（VDT）users.METHODS：Nine hundred and thirty VDT users underwent dry eye testing,and functional visual acuity（FVA）test.The blinking interval during FVA was compared with TBUT.Subjects with longer blinking interval than TBUT were considered as unstable tear film.Logistic regression analysis revealed the risk factors for unstable tear group.RESULTS：Among 930 workers,858 subjects（92.3%）participated in this study.Almost 80% of the subjects were categorized into the unstable tear group.Unstable tear group has significantly lower Schirmer values and TBUT（17.5±11.6 vs 21.1±11.5 mm,3.7±2.6 vs 5.7±2.7s,both P〈0.001）.There were no significant differences in epithelial staining or severity of symptoms.Logistic regression showed that over 40y was a risk for being unstable tear group[odds ratio（OR）=1.53;95%confidence interval（CI）=1.06-2.20].Contact lens use was protective factor for being in the unstable tear group（OR=0.37;95%CI=0.26-0.53）.CONCLUSION：Subjects with shorter TBUT than blinking interval are prevalent among VDT users.Subjects over the age of 40 shows an increased risk for unstable tear film.

Changes in Tear-Film Status and Ocular Surface Disease Index Score Following Prolonged Use of Face Mask

Background: Dry eye is characterized by tear film instability, decreased tear volume and a high Ocular Surface Disease Index (OSDI) score. Face masks have been linked to dry eye complaints in recent studies. Purpose: To evaluate the changes in tear-film status and Ocular Surface Disease Index (OSDI) score following prolonged use of face mask. Design: Cross-sectional study. Method: Patients between 18 to 70 years using masks regularly for at least 2 hours/day for at least 5 days/week from different eye-care centres in Dhaka were included. All subjects were divided into 4 groups. Mask use lasted approximately 2 hours/day in Group 1, 4 hours/day in Group 2, 6 hours/day in Group 3 and 8 hours or more/day in Group 4. Evaluation of symptoms, tear- film stability and tear volume was done by Ocular Surface Disease Index (OSDI) scores, Tear-film Break-Up Time (TBUT) and Schirmer-1 test. Average of right & left eye’s Tear-film Break Up time (TBUT) and Schirmer-1 value were noted. Results: Total 100 patients were enrolled (n = 100). The TBUT (p < 0.001) and Schirmer-1 measurement (p = 0.01) were significantly lesser and Ocular Surface Disease Index (OSDI) score were significantly higher in patients using face-masks for longer time (p < 0.001). Conclusion: Patients who wore masks for prolonged time had tear film instability, reduced tear volume and higher Ocular Surface Disease Index (OSDI) score.

两种改良手术治疗上脸内翻倒睫对脸板腺功能的影响

目的探讨两种改良手术治疗上睑内翻倒睫对睑板腺功能的影响。方法选取2019年6月~2022年6月于我院确诊为上睑内翻倒睫的80例患者作为研究对象,采用随机数字表法分组,对照组(40例)采用睑板楔形切除术(Hotz)治疗,研究组(40例)采用带蒂眼轮匝肌桥状瓣转移术治疗,比较两组患者的眼表疾病指数(OSDI)及泪膜破裂时间(BUT)、睑板腺功能情况评分、并发症发生率。结果治疗后,两组OSDI评分均下降,且研究组低于对照组,两组BUT均提高,且研究组高于对照组(P<0.05)。治疗后,两组睑板腺功能评分均上升,研究组在术后1周、1个月、2个月均高于对照组(P<0.05)。研究组术后并发症发生率为5.00%,显著低于对照组的20.00%(P<0.05)。结论带蒂眼轮匝肌桥状瓣转移术治疗上睑内翻倒睫的效果优于Hotz术式治疗效果,可提升患者的眼表功能,改善睑板腺功能,安全性高,并发症发生少,有利于改善患者的眼部健康。

准分子激光屈光性角膜术(LASIK和LASEK)对泪膜稳定性及角膜中央知觉的影响

目的:观察准分子激光角膜原位磨镶术(laser in situ keratomileusis,LASIK)和准分子激光上皮下角膜切削术(laser assisted sub-epithelial keratectomy．LASEK)前后泪膜稳定性和角膜中央知觉的变化。方法:选择80眼近视眼患者,分别行LASEK和LASIK术．每组40眼．观察患眼术前与术后1个月、3个月及6个月的角膜中央知觉、泪液分泌量(Schirmer试验)、泪膜破裂时间(break-up time．BUT),并对结果作统计学分析。结果:两种手术术后泪膜稳定性及角膜中央知觉均有不同程度的下降;LASEK术后1个月、3个月角膜中央知觉、术后1个月BUT值与术前相比有显著性差异(P<0．05);LASIK术后1个月、3个月、6个月角膜中央知觉、术后1个月、3个月BUT值与术前相比有显著性差异(P<0．05);术后1个月、3个月LASIK和LASEK组间角膜中央知觉、BUT值有显著性差异(P<0．05),LASIK组角膜中央知觉、BUT值下降更明显;LASIK和LASEK组术后1、3、6个月泪液分泌量分别与术前相比无显著性差异。结论:LASIK和LASEK手术术后均影响泪膜的稳定性与角膜中央知觉．但随着角膜的愈合而逐渐恢复;LASIK对角膜中央知觉、泪膜稳定性的破坏比LASEK更为严重、持久。

Oculus眼表综合分析仪测量LASIK术后干眼患者非侵入性泪液功能指标与干眼症状和体征之间的相关性分析

目的探讨Oculus眼表综合分析仪测量准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后干眼患者的非侵入性泪液功能指标与干眼症状、体征的相关性。方法选择鄂州市中心医院2014年9月至12月行LASIK且术后1个月被诊断为干眼的患者40例(40眼),Oculus眼表综合分析仪测量非侵入性首次泪膜破裂时间(non-invasive first tear film break-up time,NIBUTf)、非侵入性平均泪膜破裂时间(non-invasive average tear film break-up time,NIBUTav)、Oculus自动干眼分级、下泪河高度(lower tear meniscus hight,LTMH);基础泪液分泌(SchirmerⅠTest,SⅠT)、角膜荧光素染色(corneal fluorescein staining,CFS)评分、患者干眼主观症状评分。采用Spearman秩相关分析NIBUTf、NIBUTav、Oculus自动干眼分级、LTMH与SⅠT、FS、干眼主观症状评分之间的关系。结果 NIBUTf、NIBUTav与Oculus自动干眼分级均呈负相关(r=-0.430,P=0.006;r=-0.747,P=0.000);SⅠT与NIBUTf、NIBUTav、LTMH均呈正相关(r=0.459,P=0.003;r=0.394,P=0.012;r=0.733,P=0.000),SⅠT与Oculus自动干眼分级无相关性(r=-0.259,P=0.107);CFS评分与NIBUTav、LTMH均呈负相关(r=-0.466,P=0.002;r=-0.687,P=0.000),CFS评分与NIBUTf、Oculus自动干眼分级均无相关性(r=-0.189,P=0.244;r=0.301,P=0.059);干眼主观症状评分与NIBUTf、NIBUTav均呈负相关(r=-0.530,P=0.000;r=-0.700,P=0.000),与Oculus自动干眼分级呈正相关(r=0.623,P=0.000)、与LTMH无明显相关性(r=-0.243,P=0.130)。结论 Oculus眼表综合分析仪能客观地测量非侵入性泪液功能指标,与干眼其他指标存在相关性,可作为辅助LASIK术后干眼诊断和随访的有效工具。

Epi-LASIK术后角膜中央知觉及泪膜稳定性的临床观察

目的:观察微型角膜刀准分子激光上皮瓣下角膜磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)术后角膜中央知觉和泪膜稳定性的变化。方法:选择92例184眼近视患者行Epi-LASIK手术,其中低中度近视组48例96眼,高度近视组44例88眼。观察术眼术前及术后1,3,6mo的角膜中央知觉、泪膜破裂时间(break-up time,BUT)、泪液分泌量(SchirmerⅠ实验),并对结果进行统计学分析。结果:两组术后角膜中央知觉及泪膜稳定性均有不同程度的下降。低中度近视组术后1mo角膜中央知觉及BUT与术前比有显著性差异(P<0.05),术后3mo时角膜中央知觉及BUT已恢复。高度近视组术后1,3mo角膜中央知觉及BUT与术前比有显著性差异(P<0.05),术后6mo时角膜中央知觉及BUT已基本恢复。高度近视组角膜中央知觉和泪膜稳定性减退更明显,恢复时间更长。两组术后泪液分泌量(SchirmerⅠ实验)分别与术前相比无显著性差异。结论:Epi-LASIK术影响角膜中央知觉和泪膜的稳定性。高度近视对角膜中央知觉和泪膜稳定性的影响比中低度近视大而且持续时间长,但最终可随着角膜的愈合而恢复。

小牛血去蛋白提取物凝胶和羟糖苷眼液对LASIK术后角膜上皮损伤的修复作用

目的对比小牛血去蛋白提取物凝胶(兴齐制药)和羟糖苷眼液(爱尔康)在准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)后对角膜上皮损伤修复作用的功能差异,为改善术后干眼的临床用药提供帮助。方法将2010年1月至4月在我院实施LASIK手术的76例(152眼)近视患者依据术后用药进行分组,Ⅰ组为小牛血去蛋白提取物凝胶组,Ⅱ组为羟糖苷眼液组,术前和术后1个月分别行角膜荧光素染色检查,记录泪膜破裂时间(break-up time,BUT)和角膜上皮染色评分,对比两种药物对LASIK术后角膜上皮损伤修复作用的差异。结果术前、术后的BUT[术后Ⅰ组:(5.61±2.72)s,Ⅱ组:(5.42±3.17)s]和角膜上皮染色评分,组内比较差异无统计学意义(P值分别为0.877和0.092),组间比较差异亦无统计学意义(P值分别为0.683和0.212)。进一步对术前轻度干眼对象进行比较,手术前后BUT变化量组间差异无统计学意义(P=0.107),角膜上皮染色评分变化量的组间差异亦无统计学意义(P=0.181)。结论对于实施了LASIK的患者,术后为防止干眼,使用两类药物具有等同疗效,在BUT的延长上,小牛去蛋白提取物凝胶具有优势;但对于术前轻度干眼的患者,羟糖苷眼液效果更佳。

两种飞秒激光LASIK术后泪液功能的变化

目的:评估两种不同的飞秒激光制瓣准分子原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后患者在泪液功能和角膜染色方面的变化。方法:患者40眼行FS200飞秒激光制瓣LASIK手术,40眼行VisuMax飞秒激光制瓣LASIK手术。观察术前及术后1wk;1,3mo的泪膜破裂时间(tear film break-up time,TBUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)以及角膜荧光素染色(fluorescent,FL)检查。多个时间点的比较采用重复测量设计的方差分析或Kruskal—Wallis秩和检验,两组间的比较采用两独立样本t检验或Wilcoxon符号秩和检验。结果:FS200组术后的TBUT有较VisuMax组更少的趋势,但两组间的各项观察指标均没有统计学意义的差别。术后各时间点两组的TBUT值均低于术前(F=100.37,P<0.01;F=112.25,P<0.01)。两组在术后各时间点SⅠt明显低于术前(F=42.15,P<0.01;F=37.27,P<0.01)。术后1wk时FS200的FL(Z=4.28,P<0.01)和VisuMax组(Z=4.83,P<0.01)均较术前增多,但在1mo时恢复到术前水平。结论:研究表明两种飞秒激光制瓣ASIK术后的TBUT、SⅠt以及FL的变化一致,但是VisuMax飞秒制瓣LASIK术后的TBUT有比FS200飞秒制瓣LASIK手术更快恢复的趋势。

LASIK术后干眼的预后研究

目的观察准分子激光角膜原位磨镶术(LASIK)前后泪膜功能及角膜知觉的改变,初步探讨LASIK对结膜杯状细胞的影响。方法60例120眼近视眼患者行LASIK,分别于术前、术后1周,1、3、6个月行角膜知觉检查、泪膜破裂时间测定(BUT)、基础泪液分泌试验(SIt),及术前、术后1、3、6个月行结膜印迹细胞学检查。结果术后1周,1、3个月角膜知觉较术前明显下降(P<0.01)、BUT较术前明显缩短(P<0.05),均于术后6个月恢复(P>0.05);SIt值术后各时期平均值较术前均减少,但差异无统计学意义(P>0.05),术后1、3个月结膜上皮鳞状化生程度较术前明显加重(P<0.01)。结论LASIK术后可引起不同程度的角膜知觉减退、泪膜稳定性下降、眼表组织损害,但随时间延长可有不同程度的恢复。

薄瓣LASIK术后泪液功能的临床观察

目的探讨飞秒激光制瓣(femtosecond laser in situ keratomileusis,fs-LASIK)和准分子激光前弹力层下角膜磨镶术(one use-plus sub-Bowman’s keratomileusis,OUP-SBK)两种薄瓣LASIK术后患者在泪液功能和角膜染色方面的变化。方法 15例(30眼)行飞秒激光制瓣的LASIK(飞秒激光制瓣组),15例(30眼)行OUP-SBK(OUP-SBK组)。术前及术后1周、1个月、3个月行泪膜破裂时间(tear break-up time,BUT)、基础泪液分泌试验(SchirmerⅠtest,SIt)以及角膜荧光素染色(fluorescent,FL)检查。多个时间点的比较采用重复测量设计的方差分析或Kruskal-Wallis秩和检验,两组间的比较采用两独立样本t检验或秩和检验。结果 fs-LASIK组、OUP-SBK组角膜瓣厚度分别为(105.5±2.7)μm、(103.2±12.5)μm,两组间差异无统计学意义(P>0.05)。术后各时间点飞秒激光制瓣组(F=95.48,P<0.01)和OUP-SBK组(F=78.25,P<0.01)的BUT值均明显低于术前。飞秒激光制瓣组(F=26.96,P<0.01)和OUP-SBK组(F=32.11,P<0.01)术后各时间点的SIt值明显低于术前。术后1周时飞秒激光制瓣组(Z=4.72,P<0.008)和OUP-SBK组(Z=4.18,P<0.008)的FL均较术前增多、术后1个月、3个月时与术前差异均无统计意义(均为P>0.008)。两组间各时间点的各项观察指标差异均无统计学意义(均无P>0.05)。结论飞秒激光制瓣LASIK和OUP-SBK两种术后的BUT、SIt值和FL变化一致,术后的泪膜稳定性和分泌功能随着时间的推移逐渐恢复,且两者的角膜组织损伤均在早期得到修复。

PRK前后泪膜稳定性的比较

目的 :探讨PRK手术与泪膜稳定性的关系。方法 :对 6 8例 (132眼 )PRK手术患者观察术前 ,术后三天、术后十天的干眼症状、泪膜形态、泪膜稳定性 (侵犯性及非侵犯性泪膜破裂时间 )、屈光度及角膜上皮情况。结果 :PRK术后短时间内泪膜稳定性下降 ;术前泪膜破裂时间 (BUT)≤ 10秒者 ,术后角膜上皮愈合差且干眼症状明显。结论 :术前检查泪膜破裂时间对观察PRK手术与泪膜的关系有帮助。

LASIK术后眼部不适泪液学分析

目的 分析LASIK术后眼部不适患者的泪液学特征。方法 对 3 8例 (76眼 )LASIK术后 1月内眼部不适患者进行SchirmerⅠ试验和泪膜破膜时间 (BUT)测定。结果 平均泪液分泌量 >10mm者 5例 (10眼 )占 13 . 16%;平均泪液分泌量 10～ 5mm者 2 4例 (4 8眼 )占 63 . 16%;平均泪液分泌量 <5mm者 9例 (18眼 )占 2 3. 68%。上述患者术后平均时间为 2 3天 ,BUT为 15～ 3 5s者 3例 (6眼 )占 7 90 %;BUT为 15～ 10s者 4例 (8眼 )占 10 . 5 3 %;BUT <10s者 3 1例 (62眼 )占 81. 5 8%。结论 大部分患者在LASIK术后 4周以内泪液分泌量不足 ,泪膜稳定性下降。要加强局部护理 ,勤滴人工泪液。手术中尽量减少组织上皮的损伤。

Prevalence of Dry Eye and Its Association with Various Risk Factors in Rural Setup of Western Uttar Pradesh in a Tertiary Care Hospital

Purpose: To study the prevalence of dry eye in a hospital based population of rural setup and to evaluate its association with various risk factors. Material and Methods: In this cross sectional study, patients above 20 years of age were screened randomly for dry eye. An 8 points questionnaires, slit lamp examination of meibomian glands, tear film breakup time, fluorescein staining of cornea, schirmer test were used to diagnose dry eye. The diagnosis was made when three of the five parameters were positive. The role of various occupations as well as role of different exposure factors like sunlight, excessive wind, smoking, drugs, and air pollution as dry eye risk factors was accessed. Result: Out of 445, 45.39% patients had dry eye. Dry eye prevalence was higher in those above 70 years of age (74%). It was higher in male population (51.82%) compare to female population (37.37%), nearly equal in rural (46.04%) and urban population (44.31%) and highest among factory workers (90%). Correlation of dry eye with drugs (P = 0.0002), sunlight/high temperature (P = 0.0003) and smoking (P = 0.03) were significant. Conclusion: This is a hospital based study which provides prevalence of dry eye in rural region of western Uttar Pradesh. It is more common in old age male population and significantly higher in factory workers. Out of different modifiable risk factors most important are drugs, sunlight/high temperature and smoking.

不同脂质层厚度干眼患者泪膜稳定性的观察研究

目的:探讨不同脂质层厚度条件下泪膜稳定性的差异。方法:纳入2020-06/2021-12于我院就诊的干眼患者194例384眼,应用角膜地形图仪行双眼泪河高度、首次泪膜破裂时间和脂质层厚度测量,分析不同脂质层厚度条件下双眼泪河高度、首次泪膜破裂时间的差异及其相关性。结果:根据脂质层厚度将纳入患者(384眼)分为脂质丰富组(49眼)、脂质平衡组(27眼)、脂质轻微缺乏组(266眼)、脂质显著缺乏组(42眼),四组泪河高度有差异(P=0.022),首次泪膜破裂时间无差异(P=0.322)。脂质层厚度分级与泪河高度呈正相关(r_(s)=0.143,P=0.006),与首次泪膜破裂时间无相关性(r_(s)=-0.090,P=0.083);泪河高度与首次泪膜破裂时间也无相关性(r_(s)=0.038,P=0.460)。结论:泪膜脂质层厚度不同的干眼患者泪膜稳定性无明显差异。

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。

闭角型青光眼合并白内障急性发作眼与对侧眼术后眼表变化

目的:探讨原发性闭角型青光眼(PACG)合并白内障急性发作眼与对侧眼术后眼表变化。方法:选取2021-01/2022-01于郑州大学附属郑州中心医院就诊的单眼发作的急性PACG合并白内障患者40例,急性发作眼行小梁切除术联合超声乳化白内障吸除人工晶状体植入术,对侧眼行超声乳化白内障吸除人工晶状体植入术,分别于术前、术后1、3、6mo行眼表疾病指数(OSDI)问卷调查及非侵入性首次泪膜破裂时间(NifBUT)、非侵入性平均泪膜破裂时间(NiaBUT)、泪河高度(TMH)检查。结果:纳入患者术后1、3mo OSDI评分(14.72±3.07、11.39±2.24分)较术前(9.68±1.98分)明显升高(均P<0.0083),术后6mo(10.18±1.84分)与术前无明显差异;发作眼术后1、3mo NifBUT较术前明显降低,术后1、3、6mo NiaBUT较术前明显降低(均P<0.0083);对侧眼术后1mo NifBUT和NiaBUT较术前均明显降低(均P<0.0083),术后3、6mo与术前无明显差异。手术前后纳入患者发作眼和对侧眼TMH均无差异(P>0.05)。结论:PACG合并白内障术后泪膜稳定性下降,发作眼恢复需6mo甚至更长,对侧眼约需3mo。

Ocular surface microbiota in patients with varying degrees of dry eye severity

AIM:To elucidate the profiles of commensal bacteria on the ocular surfaces of patients with varying severity of dry eye(DE).METHODS:The single-center,prospective,case-control,observational study categorized all participants into three distinct groups:1)control group(n=61),2)mild DE group(n=56),and 3)moderate-to-severe DE group(n=82).Schirmer’s tear secretion strips were used,and the bacterial microbiota was analyzed using 16S ribosomal ribonucleic acid gene sequencing.RESULTS:The three groups had significant differences in alpha diversity:the control group had the highest richness(Chao1,Faith’s phylogenetic diversity),the mild DE group showed the highest diversity(Shannon,Simpson),and the moderate-to-severe DE group had the lowest of the above-mentioned indices.DE severity was positively correlated with a reduction in beta diversity of the microbial community,with the moderate-to-severe DE group exhibiting the lowest beta diversity.Linear discriminant analysis effect size presented distinct dominant taxa that significantly differed between each.Furthermore,the exacerbation of DE corresponded with the enrichment of certain pathogenic bacteria,as determined by random forest analysis.CONCLUSION:As DE severity worsens,microbial community diversity tends to decrease.DE development corresponds with changes in microbial constituents,primarily characterized by reduced microbial diversity and a more homogenous species composition.

A randomized,fellow eye,comparison of keratometry,aberrometry,tear film,axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

Background:To investigate the effect of eye rubbing on keratometry(K),aberrometry,tear film break-up-time(TFBUT)and anterior chamber depth(ACD).Methods:Volunteers without any corneal pathology or dry eyes were randomised to rubbing in one eye and the fellow-eye was control.Eye rubbing was performed for 2 min.Primary outcomes studied were anterior and posterior K changes.Secondary outcomes were changes in TFBUT,axial length(AL)&ACD,K changes in various zones,asphericity and aberrometry.Pre and post rubbing K,aberrometry,ACD and TFBUT were assessed in a predetermined sequence.The relationship of the above parameters to axial length(AL)was also assessed.Astigmatism was analysed using vector analysis.Results:Pre versus post rubbing,anterior flatter K further flattened(42.51±1.52 D vs.42.36±1.53 D,p=0.003)and the changes to J0 vector in central cornea(−0.16±0.26 D vs.-0.27±0.33 D,p=0.038)suggested change to against-the-rule(ATR)astigmatism.There was significant change in Z^(+2)_(2) polynomial following rubbing.We found a positive correlation between axial length and change in posterior K(r=0.335,p=0.020).The TFBUT reduced following eye rubbing(15.3 s vs.13.9 s,p=0.0001).There was a positive correlation between AL and increase in ACD post rubbing(r=0.300,p=0.038).There was a positive correlation between ACD and change in mean posterior K(r=0.305,p=0.035).Conclusions:In healthy eyes,following eye rubbing,there is a significant change in TFBUT and central anterior K changes towards ATR astigmatism.Longer eyes had more changes in posterior K and ACD.Whereas,eyes with deeper ACD showed more steepness of posterior K.

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。