人工泪液对糖尿病干眼患者泪河的影响

目的探讨2型糖尿病干眼患者使用人工泪液后泪河的变化。方法随机选取2型糖尿病干眼患者50例(100眼)、正常对照者50例(100眼)。糖尿病干眼患者使用人工泪液眼液治疗1个月。采用眼前节相干光学断层扫描仪记录并比较治疗前后患者的泪河高度(tear meniscus height,TMH)、泪河深度(tear meniscus depth,TMD)以及泪河横截面面积(tear meniscus area,TMA)。结果治疗前糖尿病干眼组TMH为(0.184±0.036)mm,正常对照组(0.218±0.041)mm(t=6.232,P<0.01);糖尿病干眼组TMD为(0.165±0.017)mm,正常对照组(0.192±0.009)mm(t=14.037,P<0.01);糖尿病干眼组TMA为(0.021±0.082)mm2,正常对照组(0.052±0.013)mm2(t=3.734,P<0.01)。糖尿病干眼组使用人工泪液1个月后TMD为(0.197±0.014)mm,TMH为(0.181±0.012)mm、TMA为(0.049±0.051)mm2,各项均较使用前显著增加(TMH:t=3.366、P<0.01;TMD:t=7.689、P<0.01;TMA:t=2.900、P<0.01)。结论人工泪液可以有效地改善糖尿病干眼患者的泪河状态,眼前节光学相干断层扫描仪可以作为糖尿病干眼诊断和疗效评价的重要手段,但具体的评估标准有待更大样本、更加详细的临床研究。     

过敏性结膜炎泪膜改变与干眼症的相关性浅析

目的：研究过敏性结膜炎泪膜功能的变化与干眼症发生的相关性,以更好的指导临床治疗。 方法：选取50例眼科门诊诊断为过敏性结膜炎的患者为观察组,按1∶1对照随机选取50例无眼表疾病、干眼症和全身疾病的健康人为对照组,分别进行角膜荧光素（ FL ）染色检查、泪膜破裂时间（BUT）、基础泪液分泌试验（SⅠt）、泪河线高度（ TMH）测量和裂隙灯检查。 结果：观察组左眼与右眼FL,SⅠt,BUT,TMH间存在相关性,差别有统计学意义（P〈0.05）;观察组与对照组患者FL、BUT评分差异有统计学意义（ P〈0.05）;观察组患者中TMH与SⅠt间呈正相关,FL与BUT呈负相关,且差别均具有统计学意义（P〈0.05）。 结论：过敏性结膜炎可因炎症介质的介入引发泪膜稳定性变化,从而导致干眼症发生。过敏性结膜炎泪膜稳定性变化与角膜上皮损害程度相关。     

干眼患者使用表面麻醉剂后泪河形态的改变

目的：探讨干眼患者使用表面麻醉剂后泪河的变化。
　　方法：随机选取干眼患者50例。随机选取一眼滴用表面麻醉剂纳入试验组,另一眼用9g/L生理盐水点眼纳入对照组,点药15 min 后通过眼前节相干光学断层扫描仪( anterior segment optical coherence tomography,AS-OCT)记录并比较两组的泪河高度( tear meniscus height,TMH)、泪河深度( tear meniscus depth,TMD)以及泪河横截面面积( tear meniscus area,TMA)。
　　结果：表面麻醉剂使用后TMH为0.173±0.040mm,TMD为0.166±0.019mm,TMA为0.049±0.013mm2,与点药前相比,差异均有统计学意义( tTMH=2.78,P<0.01;tTMD=2.31,P<0.01;tTMA=2.69,P<0.01),点药后两组相比,差异均有统计学意义(tTMH=5.87,P<0.01;tTMD=2.04,P<0.05;tTMA=4.63,P<0.01)。
　　结论：表面麻醉剂减少干眼患者泪液分泌量,临床工作中应加强预防和干预。     

前节OCT泪河测量的相关参数在干眼诊断中的应用研究

目的 探讨前节相干光断层扫描（optical coherence tomography, OCT）测量泪河的相关参数与干眼诊断指标间的相关性,并对其在干眼诊断中的敏感性和特异性进行分析。设计 前瞻性病例系列。研究对象 2015年6-12月北京同仁眼科中心干眼患者69例（69眼）及对照组44例（44眼）。方法 所有被检查者均按如下顺序进行检查：眼表疾病评分指数（ocular surface disease index, OSDI）问卷调查、泪河的OCT测量、泪膜干涉成像仪检查、泪膜破裂时间（BUT）测定、角结膜荧光素染色、基础泪液分泌试验（SchirmerⅠ）。比较干眼组与正常对照组各项参数的差异。干眼组中各参数相关性分析使用Spearman相关分析法,各参数敏感性及特异性采用受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）来计算。主要指标 OSDI评分、BUT、Schirmer I、角结膜染色评分、泪膜脂质层评分、泪河高度（tear meniscus height,TMH）、泪河深度（tear meniscus depth,TMD）及泪河横截面积（tear meniscus area,THA）。结果 干眼组患者OSDI评分（49.03 ±22.791）、角结膜染色评分（1.18±1.84）明显高于对照组的（8.91 ±4.99）和（0.24 ± 0.52）（P<0.001、 P=0.016);干眼组患者BUT （4.32 ±1.92 s）及Schirmer I（4.29 ±3.77 mm）明显低于对照组的（7.43 ±5.39 s）及（7.48 ±3.65 mm） （P<0.001、P=0.006）。两组泪膜脂质层评分无明显统计学差异 （P=0.158）。干眼组患者TMD、TMH、TMA平均值分别为（127.12 ± 86.95）μm、（152.52 ± 125.15）μm、（12119 ± 1342）μm2,均明显小于对照组的（188.25±87.38）μm、（235.41±135.90）μm、（23099 ±1965）μm2（P<0.001、0.001、0.001）。干眼组TMD、TMH、TMA值三项参数分别与OSDI、Schirmer I、TBUT之间有相关性（P均<0.05）,其诊断干眼的AUC值分别为0.934、0.890、0.925。结论 前节OCT检测的泪河相关参数与干眼临床诊断的指标（OSDI、TBUT、Schirmer I）存在较好的相关性,是一种较为可靠的干眼诊断及随诊方法。     

药物治疗干眼症的对比研究

目的:观察贝复舒滴眼液联合泪然滴眼液对干眼症的疗效。方法:将134例干眼症患者随机分为试验组(69例)和对照组(65例),试验组应用泪然滴眼液联合贝复舒滴眼液,各4次/d,连用1mo;对照组应用泪然滴眼液,4次/d,连用1mo。分别做基础泪液分泌试验(SⅠt)、泪膜破裂时间检查(BUT),对结果进行统计学分析。结果:两组用药前SⅠt,BUT无显著性差异(P>0.05),治疗后,两组SⅠt,BUT均有统计学意义(P<0.01),试验组治疗前后SⅠt,BUT结果比较有统计学意义(P<0.01)。结论:贝复舒滴眼液联合泪然滴眼液对干眼症有良好的效果。     

重组牛bFGF对超声乳化联合IOL植入术后干眼的疗效

目的:评价重组牛碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)在白内障超声乳化联合人工晶状体(intraocular lens,IOL)植入术后干眼症状治疗中的应用价值.方法:选取140例140眼白内障超声乳化联合IOL植入术后干眼患者,随机分为对照组和观察组,分别使用聚乙二醇滴眼液和聚乙二醇滴眼液联合重组牛bFGF眼用凝胶治疗.在治疗前和治疗后1 mo进行干眼症状评分和基础泪液分泌试验Ⅰ (Schirmer Ⅰ test,SⅠt)、泪膜破裂时间(tear break-up time,BUT)、角膜荧光素染色检测,统计分析两组疗效差异.结果:治疗前两组患者干眼症状评分和SⅠt、BUT均无统计学差异(P＞0.05).治疗后经配对t检验发现以上三个测量值在两组内比较,差异有统计学意义(P＜0.05),均有明显改善.但治疗后组间比较仅发现观察组的干眼症状评分和BUT明显优于对照组,差异有统计学意义(P＜0.05),观察组的角膜荧光素染色评分下降率显著高于对照组,差异有统计学意义(P＜0.05).结论:针对白内障超声乳化联合IOL植入术后干眼的治疗,联合应用传统人工泪液聚乙二醇和重组牛bFGF较单独应用聚乙二醇可显著改善患者眼部不适,明显延长BUT,有效降低角膜荧光素染色评分,疗效更为理想.     

飞秒激光制瓣LASIK术后泪膜变化及相关性分析

目的 观察飞秒激光制瓣准分子激光原位角膜磨镶术后泪膜的变化,BUT、泪液分泌试验和泪河高度的相关性.方法 临床病例系列研究.收集2013年8～9月长春爱尔眼科医院行飞秒激光制瓣LASIK术并随访3个月的患者120例(240只眼),观察术前、术后1周、1、2和3个月患者的荧光素检查的泪膜破裂时间(BUT)、Oculus角膜地形图仪检查的BUT、泪液分泌试验(S Ⅰ t)、Oculus角膜地形图仪检查的泪河高度(TMH)的变化,同时观察荧光素BUT和Oculus BUT、泪液分泌试验和Oculus泪河高度的相关性.结果 Oculus BUT:术后1周与术前相比有差异有统计学意义(P=0.00＜0.05),术后1、2、3个月与术前相比差异无统计学意义(P =0.556,0.663,0.087＞0.05).荧光素BUT:术前荧光素BUT与术后1周、l、2、3个月相比均差异有统计学意义(P =0.033,0.025,0.004,0.000＜ 0.05).Schirmer Ⅰ试验:术后1周、1个月与术前差异有统计学意义(P =0.000,0.002＜0.05),术后2、3个月与术前差异无统计学意义(P=0.776,0.753＞0.05).泪河高度:术后1周、1个月与术前相比差异有统计学意义(P =0.00＜0.05),术后2、3个月与术前相比差异无统计学意义(P =0.096,0.229＞0.05).Oculus BUT和荧光素BUT相关分析:相关关系为正相关.泪河高度和Schirmer Ⅰ相关分析:无相关关系.结论 飞秒激光制瓣准分子激光原位角膜磨镶术术后早期影响泪膜的稳定性;Oculus角膜地形图仪非侵入性BUT检查具有可靠性,重复性较好,可以作为临床干眼诊断的一个参考标准.     

更昔洛韦眼用凝胶对单纯疱疹病毒性角膜炎角膜上皮及泪膜稳定性的影响

目的探讨更昔洛韦眼用凝胶对单纯疱疹病毒性角膜炎角膜上皮及泪膜稳定性的影响。方法采用前瞻性随机双盲试验,将45例上皮型单纯疱疹病毒性角膜炎患者分3组:A组15例,用1.5g·L-1更昔洛韦凝胶滴眼;B组15例,用1g·L-1更昔洛韦滴眼液滴眼;C组15例,用1g·L-1阿昔洛韦滴眼液滴眼。双眼用药,均为每天4次,健眼观察局部用药对角膜上皮及泪膜稳定性的影响。用药前和用药后21d检查,记录健眼角膜上皮染色(fluorescein staining,FL)评分、泪膜破裂时间(break up time,BUT)、泪液分泌试验(Schirmer I test,SⅠt)和泪河高度(tear meniscus height,TMH)。结果A组用药前后FL、SⅠt及TMH均无明显改变,BUT延长;B组用药后有3例发生角膜上皮点状着色,BUT缩短率为33.33%,SⅠt和TMH改变不明显;C组用药后有6例发生角膜上皮点状着色,BUT缩短(缩短率为53·33%),SⅠt减少,TMH降低。A、C2组用药后各指标间差异有统计学意义,B组用药后BUT小于A组。结论1.5g·L-1更昔洛韦凝胶能保护眼表上皮细胞,减少药物毒性的作用,可提高泪膜稳定性,有利于促进疾病痊愈,缩短治疗时间。     

光学相干断层扫描测量下方泪河高度诊断2型糖尿病患者眼干燥症的可行性

目的 探讨应用光学相干断层扫描(optical coherence tomography,OCT)测量下方泪河高度(tear meniscus height,TMH)诊断2型糖尿病患者眼干燥症的可行性.方法 选择2011年3月至12月就诊于哈尔滨医科大学附属第四医院眼科的48例(48眼)不同程度2型糖尿病眼干燥症患者和50例(50眼)正常志愿者,应用OCT和测微目镜测量下方TMH值,采用配对t检验、组内相关系数、两独立样本t检验、单因素方差分析及Spearman秩相关分析等方法,比较正常眼组与2型糖尿病眼干燥症患者组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 OCT检测结果表明,正常眼下方TMH值[(0.257±0.048)mm]明显高于2级、3级、4级2型糖尿病眼干燥症组下方TMH值[(0.217±0.037) mm、(0.125±0.048) mm、(0.072±0.039) mm],差异均有统计学意义(均为P＜0.05),且不同程度糖尿病眼干燥症患者组间TMH值亦有明显差异(F=54.683,P=0.000).绘制受试者工作特征曲线,将诊断临界值定为0.221 mm,其敏感性为76.9％,特异性为72.6％.两研究者分析22只正常眼下方TMH值分别为(0.257 ±0.048) mm和(0.253 ±0.059) mm,同一时间两研究者独立获取并分析的24只正常眼的下方TMH值分别为(0.253±0.048)mm和(0.267±0.058)mm,同一研究者不同时间获取的22只正常眼下方TMH值分别为(0.264±0.049) mm和(0.264 ±0.041) mm,差异均无统计学意义(均为P＞0.05).OCT与测微目镜测量下方TMH值[(0.251±0.032) mm]结果呈显著正相关(r=0.658,P=0.000).结论 应用OCT测量下方TMH值具有良好的可靠性和可重复性,有望成为临床上诊断2型糖尿病患者眼干燥症的客观指标之一.     

糖尿病患者的眼表面不规则指数

目的:研究糖尿病患者在自然状态下和持续睁眼状态下眼表面规则指数的变化。方法:分别对13例糖尿病患者连续病例及13例非糖尿病对照组患者(年龄、性别匹配)检测泪液分泌试验(SchirmerⅠtest,SⅠt),泪膜破裂时间(tear break-up time,BUT),角膜荧光素染色(fluorescein staining,FL)及干眼症症状问卷调查。角膜地形图检测自然眨眼状态下及持续睁眼10s后的角膜不规则系数(irregular index,Irreg),后者模拟日常无意识眨眼次数减少的凝视状态。结果:更多糖尿病患者(9/13,对照组6/13)主诉每周至少一次出现一种以上干眼症症状。与对照组相比,糖尿病组SⅠt试验(11.4±2.5vs14.9±3.3mm/5min,P<0.01)及BUT(10.9±4.7vs13.6±3.4s,P=0.02)均明显降低。两组FL差异无显著性意义(0.59±0.65vs0.29±0.54,P=0.06)。自然状态下糖尿病组Irreg较对照组高,但差异无统计学意义(分别为1.36±0.46,1.11±0.45,P=0.06)。然而,持续睁眼10s后,糖尿病组Irreg明显增高至4.23±1.32,而对照组保持在2.08±0.60(P<0.01)。结论:糖尿病患者反射性泪液分泌及泪膜稳定性下降。持续睁眼时糖尿病患者角膜规则性指数(SRI)增加。     

Temporal changes in the tear menisci following a blink

This study investigated tear meniscus formation after a blink. Multiple images of the inferior and superior menisci, viewed en-face, were sequentially captured using a video-slitlamp that permitted the measurement of tear meniscus height (TMH). In a similar manner, tangentially viewed images were obtained of the inferior meniscus so changes in cross-sectional radius of curvature (TMR) with time could be determined. Additionally, the relationship between inferior TMH and tear volume was quantified by the successive instillation of small aliquots of fluid. In this latter experiment the inflow and outflow of tears were controlled by anaesthetizing the ocular surface and inner nose, and use of punctal plugs. The TMH of both menisci rose after a blink (p<0.01) by a similar amount (p=0.59). This suggests that capillarity is dominant over gravity in tear drainage, however, it may simply reflect that these influences are small compared to the large flow resistances that occur in thin films, hydraulic connectivity between the two menisci, or differences in their anterior-posterior width leading to unequal volume-height relationships. TMR increased with time after a blink (p<0.0001); immediately on eye opening the curvature of the inferior meniscus was approximately circular but this soon became eccentric, with the radius of its upper half exceeding that of its lower half. The growth rate of the two menisci slowed with time and this, based on theoretical considerations, is predicted to have occurred primarily because localized thinning of the tear film adjacent to the menisci markedly raised flow resistance. Inferior TMH increased linearly with the cumulative volume of instilled fluid (r2=0.98), supporting its use in the diagnosis and classification of tear anomalies, although the gradient of this relationship varied between subjects.     

Clinical assessment of the lower tear meniscus height

Purpose:  Different values of the lower tear meniscus height (TMH) can be obtained depending on the method and technique of measurement employed. This study aimed to assess (1) differences between the absolute (TMH-A), reflex (TMH-R) and fluorescein (TMH-F) lower tear meniscus heights, (2) differences between the central (TMH-R), nasal (TMH-RN) and temporal (TMH-RT) reflex lower tear meniscus heights and (3) the amount of fluorescein present in the lower tear meniscus, 5 min after fluorescein instillation (TMH-FV).
Methods:  Thirty four young healthy subjects were included in the study. The lower tear meniscus height (TMH) was measured using an eye piece graticule inserted into a slit-lamp.
Results:  Mean ± S.D. values of TMH-A, TMH-R, TMH-RN, TMH-RT, TMH-F and TMH-FV of 0.25 ± 0.08, 0.13 ± 0.05, 0.23 ± 0.06, 0.21 ± 0.05, 0.27 ± 0.11 and 0.004 ± 0.001 mm, respectively were found. The TMH-R was significantly lower than the TMH-A and the TMH-F ( p  < 0.0001). The TMH-RN and TMH-RT were significantly higher than the TMH-R ( p  < 0.0001). The TMH-F was significant higher than the TMH-FV ( p  < 0.0001). No significant differences were found between the TMH-A and TMH-F ( p  = 0.2), and between the TMH-RN and TMH-RT ( p  = 0.36).
Conclusion:  Careful instillation of fluorescein does not affect normal TMH values. Fluorescein is washed out from the lower tear meniscus 5 min after instillation. Higher values of the TMH can be found at nasal and temporal locations compared to the center of the lower eye lid.     

不同设备评估配戴夜戴型角膜塑形镜后泪膜质量的变化

目的：采用2种不同干眼检查设备评估患者配戴夜戴型角膜塑形镜后泪膜质量的变化。方法：前瞻性临床研究。选取2016年1月至2017年10月于中国医科大学附属第四医院眼科就诊并验配角膜塑形镜的患者共计118例，选取右眼数据用于统计。年龄8～18（11.8±2.5）岁。应用Keratograph 5M眼表综合分析仪观察患者在戴镜前及戴镜后1、3、6个月的泪河高度（TMH）、非侵入首次泪膜破裂时间[NIBUT（f）]和平均泪膜破裂时间[NIBUT（av）]； 同时应用DR-1型干眼仪测量患者戴镜后不同时间点泪膜脂质层光干涉图像。采用重复测量方差分析和Pearson相关分析进行数据统计。结果：TMH：戴镜后1、3、6个月与戴镜前比较差异均无统计学意义。NIBUT（f）和NIBUT（av）：戴镜后1个月的泪膜破裂时间和戴镜前比较明显缩短（均P<0.001），之后各时间点和戴镜前比较差异无统计学意义。泪膜脂质层分级：配戴角膜塑形镜后1个月较戴镜前有明显下降（P<0.001），之后各时间点与戴镜前比较差异无统计学意义。泪膜脂质层分级与泪膜破裂时间[NIBUT（f）、NIBUT（av）]之间具有相关性（r=-0.145，P=0.011；r=-0.147，P=0.019）。结论：青少年患者配戴角膜塑形镜后泪液的分泌量未受影响，但在早期降低了泪膜稳定性，随时间延长可逐渐恢复。Keratograph 5M眼表综合分析仪和DR-1型干眼仪可从不同层面上辅助干眼疾病的诊断。     

Reflective meniscometry: a non-invasive method to measure tear meniscus curvature

AIMS: To devise a method to measure tear meniscus curvature by a non-invasive specular technique. METHODS: A photographic system was devised. The system consisted of a camera and an illuminated target with a series of black and white stripes oriented parallel to the axis of the lower tear meniscus. The target was mounted on a flash gun close to the objective of a Brown macrocamera and calibrated using a graduated series of glass capillaries of known diameter, ground down to expose the inner wall. It was then applied to normal human eyes (n = 45) to measure the tear meniscus curvature. A video system was also assessed which provided qualitative online information about the tear meniscus. RESULTS: Using the photographic system, measured values for capillary radii were in excellent agreement with theoretical calculations (r2 = 0.996, p < 0.0001). The radii of curvature of lower tear menisci in normal human subjects (mean 0.365 (SD 0.153) mm, range 0.128-0.736; n = 45) were similar to those reported in the literature. Both systems demonstrated variations in meniscus shape. The video system provided stable images of human menisci over prolonged periods of time and promises to be useful for the analysis of dynamic changes in meniscus volume. CONCLUSIONS: Reflective meniscometry is a non-invasive technique providing quantitative information about tear meniscus shape and volume and of potential value in the study of ocular surface disease.     

新型角膜地形综合分析仪与McMonnies问卷在干眼诊断中的临床应用

目的　研究各项主、客观干眼检测项目之间的相关性及各项干眼检测项目与干眼诊断之间的相关性。方法　本研究为横断面研究,共纳入１１６例以“眼干”为主诉的连续的门诊患者,按序进行ＭｃＭｏｎｎｉｅｓ问卷调查,角膜地形综合分析仪测量泪河高度、非侵入式泪膜破裂时间（ｎｏｎｉｎｖａｓｉｖｅｔｅａｒｂｒｅａｋｕｐｔｉｍｅ,ＮＩ-ＢＵＴ）及眼红分析,传统的泪膜破裂时间（ｔｅａｒｂｒｅａｋｕｐｔｉｍｅ,ＢＵＴ）测定（荧光素试纸条法）,荧光素钠眼表染色,ＳｃｈｉｒｍｅｒＩ试验,并根据检测结果诊断是否患有干眼,将检测值进行相关性统计学分析。结果　１１６例连续病例中８５例诊断为干眼;无论是干眼组还是非干眼组,首次ＮＩ-ＢＵＴ均短于平均ＮＩ-ＢＵＴ,两者之间差异有统计学意义（ｔ＝－６．６３６,Ｐ＜０．００１;ｔ＝－４．６５２,Ｐ＜０．００１）。各项检测项目之间的相关性分析结果:平均ＮＩ-ＢＵＴ与ＮＩ-ＢＵＴ分级呈负相关（ｒ＝－０．９２０,Ｐ＜０．００１）;首次ＮＩ-ＢＵＴ与平均ＮＩ-ＢＵＴ呈正相关（ｒ＝０．８１５,Ｐ＜０．００１）;首次ＮＩ-ＢＵＴ与ＮＩ-ＢＵＴ分级呈负相关（ｒ＝－０．７３８,Ｐ＜０．００１）;平均ＮＩ-ＢＵＴ与角膜荧光素染色评分呈负相关（ｒ＝－０．３４８,Ｐ＜０．００１）;ＮＩ-ＢＵＴ分级与角膜荧光素染色评分呈正相关（ｒ＝０．３４１,Ｐ＜０．００１）;首次ＮＩ-ＢＵＴ与角膜荧光素染色评分呈负相关（ｒ＝－０．２９８,Ｐ＝０．００１）;首次ＮＩ-ＢＵＴ与ＭＱ问卷得分呈负相关（ｒ＝－０．１９６,Ｐ＝０．０３５）;角膜荧光素染色评分与ＭＱ问卷得分呈正相关（ｒ＝０．１８９,Ｐ＝０．０４２）。各项检测项目与干眼诊断之间的相关性分析结果:泪河高度、平均ＮＩ-ＢＵＴ、ＮＩ-ＢＵＴ分级与干眼诊断之间存在相关性,相关性由强至弱的排序为泪河高度（Ｂ＝－１８．１５２,Ｐ＜０．００１）、ＮＩ-ＢＵＴ分级（Ｂ＝７．３８９,Ｐ＜０．００１）、平均ＮＩ-ＢＵＴ（Ｂ＝０．６６５,Ｐ＝０．００５）,而首次ＮＩ-ＢＵＴ与干眼诊断之间并无相关性（Ｂ＝－０．１２８,Ｐ＝０．３４４）。结论　泪河高度、平均ＮＩ-ＢＵＴ、ＮＩ-ＢＵＴ分级与干眼诊断之间存在相关性;与首次ＮＩ-ＢＵＴ相比,平均ＮＩ-ＢＵＴ对干眼诊断的意义更大。     

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study

AIM: To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. METHODS: This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. RESULTS: The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). CONCLUSION: The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.     

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。