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.

Oculus角膜地形图观察泪膜首发破裂点位置的临床研究

目的用Oculus角膜地形图观察正常人及干眼症患者泪膜破裂的首发破裂点位置。方法本研究采用横断面观察性研究。选择26例干眼症患者为研究对象,选取21名正常志愿者作为对照组。检查指标包括干眼主观症状评分、泪膜破裂时间、角膜荧光染色、泪液分泌试验及Oculus角膜地形图检测泪膜破裂的首发破裂点位置,并比较组间差异。结果按照鼻上象限、鼻下象限、颞下象限及颞上象限的顺序,干眼症组泪膜首发破裂点发生于各象限的比例分别为8眼(15.4%)、19眼(36.5%)、10眼(19.2%)、15眼(28.8%)。正常对照组各象限比例依次为8眼(19%)、15眼(35.7%)、14眼(33.3%)、5眼(11.9%)。两组泪膜首发破裂点均最多见于鼻下象限,两组间首发破裂点位置差异无统计学意义(χ2=5.13,P=0.16)。结论利用Oculus角膜地形图可以观察泪膜破裂点的时间和位置,泪膜首发破裂点位置最易出现在鼻下象限。

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.

中频刺激瞳子髎穴位对泪液的临床观察

目的:探讨中频刺激眼部瞳子髎穴位对干眼症患者眼泪液影响的临床观察。方法:选取2019年4-5月就诊患者的单眼泪膜破裂时间<14 s的干眼症患者100例,共100患眼,其中男18眼,女82眼,年龄17~48岁,平均年龄(29.0±10.1)岁。以KBSL-1型中频眼部治疗仪对准瞳子髎进行中频治疗20 min,采用K5M眼表综合分析仪测量所有患眼治疗前后的泪河高度与非侵入性泪膜破裂时间。采用SPSS 19.0软件包对本研究所有数据进行配对t检验统计。结果:与治疗前比,中频治疗20 min后泪河高度增加,治疗前后差的均值为-0.0112[95%CI(-0.019,-0.003)],但差异无统计学意义(P>0.05);与治疗前比,中频治疗20 min后非侵入性泪膜破裂时间明显增加,治疗前后差的均值为-3.0576[95%CI(-3.936,-2.179)],差异存在统计学意义(P<0.05)。结论:中频刺激瞳子髎穴位对泪河高度没有明显增加,但作用于眼睑时的震动有助于促进睑板腺的脂质分泌,对改善泪液具有积极意义。

非侵入性泪膜功能检查在干眼诊断中的初步应用

目的采用Oculus四代角膜地形图仪分析干眼患者泪膜功能及首发破裂部位的分布情况。设计前瞻性比较性病例系列。研究对象2013年7-9月在北京同仁眼科中心就诊的干眼患者51例（51眼）及对照组86例（86眼）。方法对受检者进行眼表疾病评分指数（Ocular Surface Disease Index,OSDI）问卷调查,使用Oculus四代角膜地形图仪进行非侵入性泪膜破裂时间（noninvasive tear breakup time,NITBUT）及泪河高度（tear meniscus height,TMH）测定。分析干眼组及对照组OSDI评分、首发泪膜破裂时间（the first NITBUT,NITBUTf）、平均泪膜破裂时间（the average NITBUT,NITBUTav）及泪河高度差异及各项指标之间的相关性。以角膜中心点为圆心,1 mm间距将角膜划分为1～8环,并以横、纵坐标为界划分为四个象限,这样将角膜划分为29个区域。分析每位受检者首次泪膜破裂的部位,并比较分析两组受检者组间差异。主要指标OSDI评分、NITBUTf、NITBUTav、泪河高度及泪膜破裂首发部位。结果干眼组与对照组OSDI分值、NITBUTf及NITBUTav分别为（31.41±14.20）分和（4.80±7.40）分,（3.99±0.61）s和（8.90±3.51）s,（7.54±3.11）s和（11.76±4.30）s（P=0.000,0.000,0.016）,两组泪河高度分别为（0.22±0.098）mm和（0.25±0.096）mm（P=0.217）。OSDI评分与NITBUTf、NITBUTav呈线性负相关（r=-0.760、-0.490,P均=0.000）,NITBUTf与NITBUTav呈线性正相关（r=0.671,P=0.000）,泪河高度与OSDI评分、NITBUTf、NITBUTav均无相关性（P均〉0.05）。干眼组及对照组泪膜破裂首发部位主要分布在2~5环（分别占73.08%、75.42%）;泪膜破裂首发部位在不同环间出现的概率,两组受试者均具有统计学意义（χ2=13.897、30.017,P=0.031、0.000）。以四个象限为分区单位,干眼组及对照组泪膜破裂首发部位出现概率均无统计学意义（χ2=2.103、5.186,P=0.551、0.159）。结论 Oculus四代角膜地形图仪能客观地检查泪膜破裂时间及破裂部位;泪膜破裂时间与患者主诉症状即OSDI评分具有较显著的线性负相关;干眼患者泪膜破裂首发部位以瞳孔区角膜处发生的概率最高。