OCT在诊断视屏终端性眼病中的临床观察

目的 探讨应用光学相干断层扫描（OCT）测量下方泪河高度诊断视屏终端性眼病（VDTS）的可行性及其临床诊断价值.方法 不同程度VDTS患者40例（40眼）和正常志愿者44例（44眼）,应用OCT和测微目镜测量下方泪河高度（TMH）值,比较正常眼组与VDTS患者组TMH值、两研究者分析同一检查者获取的TMH值、两研究者同一时间获取的同一组人的TMH值、同一研究者1周前后重复的测量值,以及比较OCT获得的TMH值与裂隙灯显微镜下测微目镜获得的TMH值.结果 两研究者分析24只正常眼下方TMH值分别为（0.258±0.008） mm和（0.252±0.041） mm,同一时间两研究者独立获取并分析的26只正常眼的下方TMH值分别为（0.256±0.012） mm和（0.257±0.018）mm,同一研究者不同时间获取的24只正常眼下方TMH值分别为（0.260±0.11） mm和（0.262±0.021） mm,无显著性差异（均为P＞0.05）.OCT与测微目镜测量下方TMH结果呈正相关（r=0.689,P＜0.001）,正常眼下方TMH值（0.267±0.038） mm]明显高于视屏终端性眼病（VDTS）组下方TMH值（0.226±0.029） mm],有显著性差异（P＜0.05）,绘制受试者工作特征曲线,将诊断临界值定为0.218mm,其敏感性为78.1％,特异性为72.4％.结论 应用OCT测量下方TMH值具有良好的可靠性和重复性,对VDTS患者的诊断准确性高,可行性好,有望成为临床上诊断VDTS的客观指标之一.

Application of OCT Analysis in Diagnosis of VDTS

Objective To investigate the reproducibility and repeatability of OCT for measuring the tear meniscus height （TMH） and to evaluate its clinical application in the diagnosis of VDTS. Methods The TMH of 40 patients （40 eyes） with VDTS and 44 eyes of 44 normal volunteers were measured by OCT and slit lamp marker lens in Heze Munici- pal Hospital ophthalmology from August 2012 to August 2013. To analyze and compare the TMH values between normal subjects and patients with VDTS, between that of one examinee measured by two different examiners, and between that of one group measured by two analysts at the sametime ,and between the TMH values two examinations measured by a ex- aminer within aweek, between that measured using anterior segment OCT and using slit lamp with mi-crometer eye-piece. Results There was no significant difference between different obseervers for the same 24 OCT pictures TMH： （ 0.258＋_ O. 008） mm and （ 0. 252 ±0.041） mm] ,values of the same 26 subjects measured by different examiners（0.256±0.012） mm and （0.257±0.018） mm ] , betweenTMH values of the same 24 subjects measured by a same observer in different check- points （0.260±0.011） mm and （ 0.262±0.021） mm ] （P〉O.05）. There is a positive correlation beteen normal subjects and patients with VDTS （P〈O.05） , There was a highly positive correlation between TMH values measured by OCT and slit lamp with micrometer eye-piece（ r = 0.689 ,P〈 0.001）. The sensitivity and specificity of TMH value with OCT for VDTs diagnasis was 78.1% and 72.4% when the diagnostic value was set to be 0.218 mm under the instruction of receptor operat- ing characteristics curve. Conclusion OCT has excellent reliability and repeatabili-ty for measuring the TMH, and it is accurate and highly feasible, and can be taken as an objective clinical imaging method for the diagnosis of VDTS.