干眼患者泪液中Nod样受体1表达水平及其与临床指标的相关性

目的 探究核苷酸结合寡聚化结构域样受体1(Nod-1)在人泪液中的表达水平及其与临床干眼的相关性。方法 选取2021年1月至2021年6月就诊于延边大学附属医院眼科门诊受试者50名(右眼),其中干眼患者27眼(干眼组),健康人23眼(对照组)。通过分析眼表疾病指数(OSDI)问卷评分、泪膜破裂时间(BUT)、泪液分泌实验(SⅠT)、角膜荧光素染色(FL)评分以及泪液中Nod-1受体蛋白、核因子kappa B p65(NF-κB p65)蛋白和白细胞介素-1β(IL-1β)的表达水平,确定Nod-1受体蛋白和眼表参数之间的相关性。结果 干眼组和对照组受试者的OSDI评分、BUT、SⅠT、FL评分差异均有统计学意义(均为P<0.001)。干眼组患者的Nod-1受体蛋白、NF-κB p65蛋白、IL-1β表达水平均显著高于对照组,差异均有统计学意义(均为P<0.001)。干眼组患者中,Nod-1受体蛋白、NF-κB p65蛋白、IL-1β的表达水平与OSDI评分、FL评分均呈正相关性(均为P<0.05),与SⅠT均呈负相关性(均为P<0.05),与BUT均无明显相关性...     

不同手术方式对翼状胬肉患者泪液功能的影响

目的:探讨不同手术方式对翼状胬肉患者泪液功能的影响及其可能机制。方法:翼状胬肉患者50例50眼,随机分成两组,A组30例30眼行翼状胬肉切除联合带蒂结膜瓣移植术,B组20例20眼行翼状胬肉切除联合自体角膜缘干细胞移植术,分别于术前和术后1,3mo检查泪膜破裂时间(BUT)、SchirmerI试验、角结膜荧光素染色(CFS)、泪液羊齿状物试验(TFT),采用眼表疾病指数(OSDI)评价胬肉及胬肉切除术后泪液功能变化对患者生活质量的影响,并作统计学分析。结果:两组术后1moBUT缩短、CFS增多、OSDI变高、泪液羊齿结晶形成较差,和术前比较差异有显著意义(P<0.05),而术后1moSchirmerI和术前比较差异无显著意义。两组术后3moBUT,SchirmerI,CFS,OSDI,TFT和术前比较差异无显著意义。术后1moB组BUT较A组长,CFS较A组少,OSDI较A组高,泪液羊齿结晶形成较A组良好,差异有显著意义(P<0.05),而术后1mo两组SchirmerI比较差异均无显著意义。术后3mo两组BUT,SchirmerI,CFS,OSDI,TFT比较差异均无显著意义。结论:翼状胬肉切除术后早期对泪膜功能有影响,术后3mo泪膜功能恢复至术前水平。行翼状胬肉切除联合自体角膜缘干细胞移植术后早期对泪膜功能的影响小于翼状胬肉切除联合带蒂结膜瓣移植术。     

Association between the levels of prostaglandin E2 in tears and severity of dry eye

AIM: To investigate the relationship between the levels of prostaglandin E2 (PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs. METHODS: Tear samples were collected from 36 non-Sjögren syndrome dry eye patients (10 males and 26 females, mean age 50.11±11.17y). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time (TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay (ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction (MGD) were evaluated using linear regression analysis. RESULTS: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores (R=0.608, P<0.001), however, they did not significantly associate with TBUT (R=0.153, P=0.373), Schirmer scores (R=-0.098, P=0.570), ocular surface staining scores (R=0.282, P=0.095), and stage of MGD (R=-0.107, P=0.535). Male sex was significantly negatively correlated with tear PGE2 levels. CONCLUSION: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.     

A study of the association between Vitamin D deficiency and Dry Eye Syndrome (DES) in the Indian population

Purpose:A study of the association between vitamin D deficiency and dry eye syndrome (DES) in the Indian population.Methods:This was a cross-sectional, hospital-based observational study. Sixty patients diagnosed with vitamin D deficiency (<20 ng/dl) who met the inclusion criteria were sent to the Eye OPD from the Endocrinology OPD (case) were compared to 60 subjects with normal vitamin D levels (≥20 ng/dl) who attended the Eye OPD (controls). The examination of the tear film was done using Whatman filter paper in Schirmer test I and Schirmer test I (with anesthesia). The tear film break-up time (TFBUT) was determined by slit-lamp examination using the fluorescein stain, and scoring using the ocular surface disease index (OSDI) was done.Results:A significant difference in the mean values of Schirmer I and Schirmer I test (with anesthesia) (P < 0.001) was seen between the case and control groups. A significant difference in the mean values of TFBUT (P < 0.001) and OSDI scores (P < 0.01) was also seen between the two groups.Conclusion:A positive association was found between vitamin D deficiency and dry eye on comparing the above parameters.     

Ocular Surface Characteristics and Impression Cytology in Patients with Active versus Inactive Thyroid Eye Disease

 PURPOSE:To compare the clinical findings, tear film function and impression cytology between patients with active and inactive Thyroid Eye Disease (TED). METHODS:A total of 56 patients with TED and 30 controls were recruited in this prospective observational cohort study. TED patients were divided into active TED and inactive TED types according to a seven-point modified formulation of the Clinical Activity Score (CAS). All participants underwent full eye examinations including Ocular Surface Disease Index (OSDI) score, tear film break-up time (TBUT), fluorescein staining and Schirmer I test. Thirty nine patients with thyroid-associated orbitopathy (TAO) received Nelson's grade with conjunctival impression cytology. Proptosis, palpebral fissure width and lagophthalmos were assessed. RESULTS:Ocular surface parameters including proptosis, palpebral fissure width and lagophthalmos did not differ between active and inactive TED patients (P>0.05). Both active and inactive TED patients obtained higher fluorescein staining scores, lower TBUT scores and significantly lower Schirmer test scores than those of controls (P<0.001 for all). Additionally, the TBUT score was significantly lower and the OSDI score significantly higher in the active TED group compared with those in the inactive TED group (P<0.001 for both). Impression cytology revealed a higher proportion of grade 2-3 changes in the active TED group compared with the inactive TED group (P<0.001). CONCLUSION:Orbital inflammation in TED patients may lead to decreased tear film stability and ocular surface squamous metaplasia.     

糖尿病周围神经病变患者干眼的临床特征分析

目的:探讨糖尿病周围神经病变(DPN)患者泪膜功能的改变及干眼症状特征。方法:病例对照研究。选取存在泪膜异常的2型糖尿病(T2DM)患者59例59眼,以是否存在DPN分为T2DM组31例31眼和DPN组28例28眼,另选择符合泪膜异常标准且无糖尿病的患者33例33眼作为无T2DM组。对三组患者进行眼表疾病指数(OSDI)量表评分、泪膜破裂时间(BUT)、角结膜荧光素钠染色(FL)评分、泪液分泌试验(SchirmerⅠ)、红外线睑板腺照相。结果:各组间BUT结果有差异(F=9.43,P<0.01),无T2DM组、T2DM组和DPN组两两比较均有差异(P<0.05);各组间SchirmerⅠ及FL阳性率比较无差异(P>0.05);各组间睑板腺缺失评分有差异(χ2=8.433,P<0.05),T2DM组与无T2DM组比较无差异(P>0.05),DPN组与无T2DM组、T2DM组比较均有差异(P<0.05);各组间OSDI量表评分比较有差异(P<0.05),两两比较,T2DM组与无T2DM组比较无差异(P>0.05),DPN组与无T2DM组、T2DM组比较均有差异(P<0.05)。结论:合并DPN的T2DM患者较不伴发DPN的T2DM患者及无T2DM患者BUT更短、睑板腺缺失更重,但干眼症状更不明显,应密切关注和随访DPN患者的眼表异常。     

Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis

Purpose: To evaluate the clinical findings, tear film functions and ocular surface changes in patients with seborrhoeic dermatitis. Methods: This prospective study involved 63 patients with seborrhoeic dermatitis (Group 1) and 65 control subjects (Group 2). Best‐corrected visual acuity measurement, slit‐lamp examination, Schirmer I test, tear film break‐up time (BUT), Rose Bengal staining and conjunctival impression cytology were performed in all patients. Subjective ocular complaints were scored using an Ocular Surface Disease Index (OSDI) questionnaire. Results between the two groups were compared. Results: In group 1, meibomitis, blepharitis and conjunctival hyperemia were seen significantly more frequently than in group 2 (p < 0.001). Impression cytology revealed grade 0 changes in 25 (39.6%) eyes, grade 1 changes in 22 (34.9%) eyes, grade 2 changes in 13 (20.6%) eyes and grade 3 changes in 3 (4.7%) eyes in group 1, whereas grade 0 changes in 48 (73.8%) eyes, grade 1 changes in 11 (16.9%) eyes and grade 2 changes in 6 (9.2%) eyes were seen in group 2 (p = 0.032). Mean goblet cell density was 795 ± 55 cells/mm² in group 1 and 1820 ± 100 cells/mm² in group 2 (p < 0.001). Mean Schirmer I and mean BUT results were statistically lower in group 1 than in group 2 (p = 0.043 and p < 0.001, respectively). Mean Rose Bengal scores and mean OSDI scores were statistically higher in group 1 than in group 2 (p = 0.002 and p < 0.001, respectively). Conclusions: Our data show that patient with seborrhoeic dermatitis has decreased tear production, tear film instability and significant degeneration of the ocular surface epithelium, compared with normal subjects.     

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。     

应用非接触性眼表综合分析仪观察T2DM和/或高血压患者的眼表特征

目的：使用非接触性眼表综合分析仪分析2型糖尿病(T2DM)和/或高血压患者眼表特征。

方法：选取2017-01/2018-12在我院就诊的T2DM患者、高血压患者、T2DM合并高血压患者、无T2DM也无高血压患者各40例40眼,分析比较四组患者OSDI评分、泪河高度、眼红指数、角膜荧光素钠染色评分、非侵入性泪膜破裂时间(首次泪膜破裂时间和平均泪膜破裂时间)检测结果。

结果：T2DM患者眼部不适的主观感受更为明显,T2DM和/高血压患者更容易出现眼部充血的体征。与无T2DM也无高血压的患者相比,T2DM患者的泪河高度降低,平均泪膜破裂时间明显缩短(均P<0.05),但四组患者的首次泪膜破裂时间、角膜荧光素钠染色评分均无明显差异(P>0.05)。

结论：非接触性眼表综合分析仪能够无侵入地观察眼表特征,提供相对客观的量化检查结果。T2DM患者眼部稳定性较无T2DM也无高血压的患者下降,稳态更容易被打破。     

口服维生素D3治疗飞秒激光辅助LASIK术后干眼

目的：探讨口服维生素D3对飞秒激光辅助准分子激光原位角膜磨镶术（FS-LASIK）后干眼的治疗效 果。方法：前瞻性临床研究。选择2019 年1 ─12 月在柳州市工人医院接受FS-LASIK且术后1 个月有 明显干眼的患者90例（90眼）。所有患者被随机分为2组：研究组45例（45眼）,连续12周服用维生素 D3 2 000 IU/d;对照组45例（45眼）,不口服任何药物。分别在用药前及用药后第1、3、6个月测定患 者的眼表疾病指数（OSDI）、泪液破裂时间（TBUT）、Schirmer Ⅰ试验、泪河高度,血清维生素D3水平 以及对比敏感度情况。采用Kolmogorov-Smirnov、LSD-t检验和独立样本t检验进行统计分析。结果： 服药后1 个月,研究组OSDI评分均值明显低于对照组,差异有统计学意义（t=4.32,P=0.007）。研究 组的TBUT（t=3.02,P=0.027）和Schirmer Ⅰ试验值（t=2.78,P=0.030）均高于对照组。服药后3个月, 研究组OSDI（t=2.50,P=0.010）、TBUT（t=2.32,P=0.031）和Schirmer Ⅰ试验值（t=3.25,P=0.026）均优于对照组,差异均具有统计学意义。服药后6个月,2组患者OSDI（t=2.31,P=0.025）、TBUT（t=2.30, P=0.039）和Schirmer Ⅰ试验值（t=3.03,P=0.028）差异均具有统计学意义,研究组恢复更好。研究组患者血清维生素D3 水平与OSDI评分呈负相关（r=-0.90,P<0.001）,与Schirmer Ⅰ试验值（r=0.88, P<0.001）、TBUT评分（r=0.89,P<0.001）和TMH（r=0.80,P<0.001）呈正相关。服药后6个月时,研究组患者的明视对比敏感度和暗视对比敏感度均优于对照组（3 cpd：t =2.40,P=0.04;6 cpd： t=2.16, P=0.04;12 cpd：t =2.23,P=0.04;18 cpd：t =2.37,P=0.04）。结论：维生素D3不仅改善了术后干眼症状及泪膜稳定性,而且可以改善FS-LASIK术后的视觉质量。     

角膜塑形镜对青少年眼表和泪膜的影响

目的：观察夜戴型角膜塑形镜矫正青少年近视对眼表和泪膜的影响及眼表不适症状。

方法：前瞻性研究。选取12～18岁近视患者69例138眼,其中使用框架眼镜者31例,使用角膜塑形镜者38例。分别于戴镜1、3、6、12mo时进行眼表疾病指数(OSDI)和眼表染色评分(Oxford法),检测泪膜破裂时间(TBUT)、非接触性泪膜破裂时间(NIBUT)及基础泪液分泌量。

结果：与框架眼镜组和戴镜前比较,戴镜后各时间点角膜塑形镜组患者OSDI评分升高,TBUT和NIBUT均降低,且戴镜6、12mo时角膜塑型镜组患者眼表染色评分均高于框架眼镜组(均P<0.05),但戴镜前后两组患者基础泪液分泌量无明显差异(P>0.05)。

结论：角膜塑形镜会导致OSDI和眼表染色评分轻度升高,影响泪膜稳定性,应加强眼表和泪膜情况的戴镜前检查和随访,重视患者的不适主诉。     

Changes of meibomian glands in patients with type 2 diabetes mellitus

AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus (DM). METHODS: Of 118 eyes (118 patients) with type 2 DM (DM group) and 100 eyes of 100 control subjects (control group) were enrolled. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NI-BUT) and the structure of the meibomian glands (MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0 (no loss) to grade 3 (lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy (LSCM). The primary outcomes were meibomian gland acinar unit density (MGAUD), meibomian gland acinar longest diameter (MGALD) and meibomian gland acinar shortest diameter (MGASD). RESULTS: Compared with control group, the OSDI was significantly higher in DM group (Z=-5.916; P<0.001), while the NI-BUT was significantly lower (Z=-7.765; P<0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group (Z=-3.937; P<0.001). LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group (Z=-10.120, -9.4442, -7.771; P<0.001). CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye. Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.     

苏州某社区高血压患者视网膜病变与尿白蛋白/肌酐的关系

目的：探讨苏州某社区高血压患者视网膜动脉狭窄的危险因素及与尿白蛋白/肌酐的(UACR)关系,为靶器官损害的预防、延缓提供一定依据。

方法：本研究采用横断面调查的方法,纳入高血压患者1 983例,根据眼底检测情况分成正常组944例,狭窄组1 039例。收集基线资料及进行尿白蛋白/尿肌酐测定,分析视网膜动脉狭窄危险因素及与UACR的关系。

结果：两组患者年龄、糖尿病水平比较,差异均有统计学意义(P<0.05); 年龄(OR=1.013,P=0.011)、糖尿病(OR=1.352,P=0.008)为视网膜动脉狭窄的危险因素; 高血压视网膜病变(HR)检出率为95.56%,其中以Ⅰ级和Ⅱ级轻度病变为主; 两组患者白蛋白尿分组差异有统计学意义(P<0.05),其中眼底狭窄组大量白蛋白尿占比65.59%,高于微量白蛋白尿54.21%,高于正常组50.52%。

结论：年龄和糖尿病是高血压患者视网膜动脉狭窄的危险因素,视网膜病变与UACR有关系,社区应加强健康宣教,早期进行视网膜、肾脏筛查,预防、延缓病情进展。     

A型肉毒素治疗特发性眼睑痉挛后眼表改变

目的：通过比较A型肉毒素治疗特发性眼睑痉挛前后患者眼表指标的变化,探讨其对眼表稳定性的影响。方法：前瞻性研究。收集2017年1-6月就诊于延安大学附属医院眼科门诊欲行A型肉毒素注射治疗的特发性眼睑痉挛患者,分别于注射前、注射后2周采用Jankovic量表（JRS）对其病情进行评分;采用眼表疾病指数量表（OSDI）对其眼表症状进行评分;裂隙灯显微镜观察泪膜破裂时间（BUT）和角膜荧光素钠染色情况;Schirmer Ⅰ试验测定泪液分泌量。采用配对t检验和Spearman秩相关检验对所得数据进行分析。结果：共纳入特发性眼睑痉挛患者30例（60眼）,其中60%（18/30）合并干眼,且OSDI评分与JRS评分呈弱的正相关关系（r=0.278P=0.032）。所有患者经A型肉毒素注射后病情均有不同程度的缓解,JRS评分由5.5±1.0减少至0.6±1.0（t=25.730,P<0.001）。同时干眼患者中12例干眼症状也得到了缓解,OSDI评分由34.0±7.8下降为21.7±9.1（t=7.946,P<0.001）;BUT由（6.3±2.1）s增加至（8.0±2.0）s （t=4.389,P<0.001）;角膜荧光素钠染色评分也由1.0±1.0下降至0.6±0.7（t=2.963,P=0.004）,治疗前后比较差异均具有统计学意义。结论：A型肉毒素注射治疗有助于缓解特发性眼睑痉挛引起的干眼。     

Clinical efficacy of combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate in the dry eyes with meibomian gland dysfunction

AIM: To investigate the efficacy of combined topical 0.05% cyclosporine A (CsA; Restasis®, Allergan pharmaceuticals, USA) and 0.1% sodium hyaluronate treatment in dry eyes with meibomian gland dysfunction (MGD). METHODS: In a retrospective analysis, 53 patients (106 eyes) with MGD were enrolled and performed lid warm massage for 10min daily and be instilled preservative free sodium hyaluronate 0.1% eye drops 4 times daily. Patients were divided into subjects treated with topical 0.05% CsA and preservative free sodium hyaluronate vehicle (experimental group, n=74 eyes) and subjects treated with the preservative free sodium hyaluronate vehicle (control group, n=32 eyes). They were evaluated at baseline and 1, 2, and 3mo for subjective symptoms and objective signs including tear film break-up time (tBUT), Schirmer test, corneal staining (CS) score, lid margin telangiectasia (LMT), meibomian gland secretion (MGS), and conjunctival injection (CI). RESULTS: In the short-term treatment, the experimental group showed a statistically significant improvement in the ocular surface disease index (OSDI; P<0.001), tBUT (P=0.004), Schirmer test score (P=0.008) and LMT (P=0.021) by repeated measure ANOVA. Additionally, mean changes from baseline in OSDI (P<0.001), tBUT (P=0.001), Schirmer test score (P=0.029), CS score (P=0.047), LMT (P=0.002), CI (P=0.030) were improved better in the experimental group than in the control group at 3mo. However, there was no significant difference between the two groups in MGS (P=0.67). CONCLUSION: In dry eyes with MGD, 0.05% CsA improves the tear film stability as well as subjective ocular discomfort, and is effective in controlling lid margin inflammation.     

Autologous platelet-rich plasma eye drop versus artificial tear eye drop for symptomatic dry eye disease: A prospective comparative interventional study

Purpose:To evaluate and compare the efficacy of autologous platelet-rich plasma (aPRP) eye drop and artificial tear (AT) eye drop in moderate to severe symptomatic dry eye disease (DED).Methods:This prospective interventional study included 121 eyes of 61 patients of moderate to severe DED. Patients were divided into aPRP (31 patients) and AT (30 patients) group. Ocular Surface Disease Index (OSDI) score, tear film breakup time (TBUT) (s), corneal fluorescein staining (CFS) score, and Schirmer test score (mm) of both the groups were evaluated and compared pre-treatment and post-treatment at the end of 3 months.Results:The mean age of the aPRP group and AT group was 52.8 ± 12.8 years and 55.5 ± 13.4 years, respectively. At the end of 3 months, OSDI score reduced more in the aPRP group as compared to AT group, and the mean difference (−22.7) was statistically significant (P < 0.001). There was no significant difference in post-treatment Schirmer test score between the two groups (P = 0.44). Post-treatment improvement in TBUT and CFS score in the aPRP group was significantly higher in the aPRP group as compared to that in the AT group (P < 0.05). Bruising at the site of blood withdrawal was noted in two patients in the aPRP group.Conclusion:aPRP is safe and more effective than AT in treating patients with moderate to severe symptomatic DED.     

季节性过敏性结膜炎对糖尿病患者眼表影响的临床研究

目的探讨季节性过敏性结膜炎(SAC)对糖尿病患者眼表的影响。 方法选取2019年2月至2019年8月于南京大学医院眼科就诊的糖尿病患者80例(160只眼)。其中,男性49例,女性31例;年龄41~76岁,平均年龄(58.5±8.2)岁。SAC发作期的糖尿病患者40例(80只眼)为观察组;糖尿病常规眼科体检者40例(80只眼)为对照组。观察并记录患者发作时与病情缓解后的眼表疾病指数(OSDI)、泪液分泌量(SⅠt)、泪河线高度(TMH)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)及睑板腺综合评分,并以均数±标准差表示。观察组与对照组患者发作期和缓解期眼表各相关参数的比较,采用单因素方差分析;各参数的相关性,采用Spearman非参数检验。 结果两组患者性别的比较,差异无统计学意义(χ²＝0.891,P>0.05);两组患者年龄、糖尿病病程、空腹血糖、糖化血红蛋白、最佳矫正视力及眼压的比较,差异无统计学意义(t＝0.925,1.218,0.787,1.014,0.962, 1.231;P>0.05)。观察组发作期患者的OSDI、BUT、FL及睑板腺综合评分分别为(44.79±17.26)、(5.47±2.30)s、(1.45±1.13)及(3.75±2.20),对照组分别为(28.49±9.18)、(10.39±3.66)s、(0.98±0.80)及(2.83±1.95),差异有统计学意义(F＝36.387、14.015、4.293,6.011;P<0.05)。与对照组相比,观察组发作期糖尿病患者的OSDI、FL及睑板腺综合评分增高,但BUT缩短。两组患者OSDI、FL、睑板腺综合评分及BUT的比较,差异均有统计学意义(t＝9.386,8.230,5.795,-6.016;P<0.05)。经治疗缓解后,各项相关参数有所改善,OSDI和睑板腺综合评分仍高于对照组,BUT低于对照组。观察组缓解期患者的OSDI、睑板腺综合评分及BUT分别为(35.89±10.76)、(1.10±0.84)及(8.40±3.72)s,差异有统计学意义(t＝4.587,3.840,-6.233;P<0.05)。两组患者SⅠt和TMH的比较,差异无统计学意义(F＝2.185,1.214;P>0.05)。观察组发作期糖尿病患者的OSDI与SⅠt、TMH及BUT呈负相关。经Spearman相关分析,其相关性有统计学意义(r＝-0.652,-0.640,-0.343;P<0.05)。OSDI与FL和睑板腺综合评分呈正相关。经Spearman相关分析,其相关性有统计学意义(r＝0.679,0.817;P<0.05)。SⅠt与TMH呈正相关。经Spearman相关分析,其相关性有统计学意义(r＝0.745,P<0.05)。BUT与FL和睑板腺综合评分呈负相关。经Spearman相关分析,其相关性有统计学意义(r＝-0.521,-0.559;P<0.05)。观察组SAC缓解期糖尿病患者的OSDI与TMH和BUT呈负相关。经Spearman相关分析,其相关性有统计学意义(r＝-0.321,-0.398;P<0.05)。OSDI与睑板腺综合评分呈正相关。经Spearman相关分析,其相关性有统计学意义(r＝0.272,P<0.05)。SⅠt与TMH呈正相关。经Spearman相关分析,其相关性有统计学意义(r＝0.799,P<0.05)。BUT与FL和睑板腺综合评分呈负相关。经Spearman相关分析,其相关性有统计学意义(r＝-0.697,-0.602;P<0.05)。 结论SAC对糖尿病患者眼表的OSDI、FL、BUT及睑板腺综合评分均有影响,但对SⅠt及TMH的影响不大;SAC缓解期患者眼表的OSDI、BUT及睑板腺综合评分恢复较慢;OSDI与SⅠt、TMH、BUT、FL及睑板腺综合评分等眼表相关参数有着良好的一致性。     

Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus

Background: Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). Methods: Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. Results: The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). Conclusion: GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.     

睑板腺功能障碍患者眼表特征性变化及其与吸烟行为关系的临床研究

目的探讨睑板腺功能障碍(MGD)患者眼表特征性变化与其吸烟行为的关系。 方法横断面研究。收集2016年3月至11月由首都医科大学附属北京同仁医院、北京市眼科研究所组织陕西省西安市第一医院、中国医学科学院北京协和医院及暨南大学附属第一医院等23家多中心医疗单位眼科门诊连续观察的MGD患者923例和健康志愿者114例,分别命名为MGD组和对照组。其中,MGD组男性330例,女性593例;年龄18~88岁,平均年龄(42.54±13.62)岁。对照组男性23例,女性91例;年龄18~88岁,平均年龄(41.96±17.11)岁。所有对象均检查右眼眼表疾病指数(OSDI)填写吸烟评估量表,检测泪膜破裂时间(TBUT)、角结膜荧光素染色、Schirmer Ⅰ检查、睑板腺缺失率、泪膜脂质层厚度及睑板腺分泌物。其中,MGD组与对照组、吸烟组与非吸烟组患者眼表测量值的比较采用独立样本t检验;不同年龄MGD患者眼表指标的比较采用单因素方差分析;吸烟率构成比的比较采用卡方检验。 结果MGD组患者OSDI评分(33.07±16.50)高于对照组(20.12±14.04),具有统计学意义(t＝9.104,P<0.05);TBUT值为(4.31±2.51)s低于对照组的(6.06±3.91)s,差异有统计学意义(t＝-4.654,P<0.05);MGD组患者角结膜染色评分(0.69±1.18)高于对照组的(0.50±1.06),差异有统计学意义(t＝1.787,P<0.05); MGD组患者Schirmer Ⅰ值(10.10±7.95)mm与对照组的(9.63±8.53)mm比较,无统计学意义(t＝-0.552,P>0.05);MGD组患者睑板腺缺失率(14.35±12.18)与对照组的(12.31±11.93)比较,差异无统计学意义(t＝1.697,P>0.05);MGD组患者睑缘异常评分(4.47±3.76)高于对照组的(5.57±3.66),差异有统计学意义(t＝-2.943,P<0.05);MGD组患者睑板腺显像评分(1.39±1.95)及睑脂评分(9.34±7.56)均高于对照组的(5.57±3.66)及(13.34±9.35),差异有统计学意义(t＝-4.765,-4.403;P<0.05);MGD组患者脂质层厚度(62.32±24.88)与对照组的(64.98±21.19)比较,差异无统计学意义(t＝-1.094,P>0.05),MGD组患者不完全眨眼率(0.56±0.35)与对照组的(0.66±0.65)比较,差异无统计学意义(t＝-1.570,P>0.05)。18~29岁、30~39岁、40~49岁、50~59岁及60岁以上MGD患者OSDI检查结果随年龄增加而加重。OSDI、TBUT、Schirmer Ⅰ值及睑板腺缺失率的比较,差异均有统计学意义(F＝2.194,3.866,15.904,9.030;P<0.05)。MGD患者吸烟率为10.40%,高于对照组的5.26%,差异有统计学意义(χ²＝4.176,P<0.05);MGD患者吸烟指数为(159.36±26.83)高于对照组的(73.15±12.16),差异有统计学意义(t＝3.906,P<0.05)。MGD组内,男性吸烟率为91.8%,高于女性的8.2%,差异有统计学意义(χ²＝110.04,P<0.05)。吸烟患者的Schirmer Ⅰ值为(10.22±8.13)高于对照组的(8.00±6.10),差异有统计学意义(t＝2.99,P<0.05);吸烟患者平均脂质层厚度为(63.30±24.86)高于对照组的(54.22±17.74),差异有统计学意义(t＝3.16,P<0.05);吸烟患者睑缘异常评分为(4.49±3.66)低于对照组的(5.86±4.70),差异有统计学意义(t＝-2.51,P<0.05);吸烟患者睑脂评分为(9.61±7.76)低于对照组的(11.85±8.91),差异有统计学意义(t＝-2.15,P<0.05)。 结论MGD患者OSDI和角结膜染色评分提高,TBUT、睑缘异常、睑板腺显像及睑脂评分降低;而OSDI、TBUT、Schirmer Ⅰ值及睑板腺缺失率,患者眼表症状随其年龄增加而加重;MGD患者中吸烟率和吸烟指数高,且吸烟组中患者角结膜染色增高、睑缘异常评分增高、睑板腺显象评分增高,而脂质层厚度减小,吸烟行为是睑板腺功能障碍的危险因素。     

Evaluation of dry eye signs and symptoms in patients with systemic sclerosis

Background

One of the most frequent ocular features of systemic sclerosis (SSc) is dry eye disease (DED), which has been identified to occur in 37–79% of patients. Although several studies have found weak or no correlations between symptoms and signs of dry eye, symptoms are often the motivation for seeking eye care, and are therefore a critical outcome measure when assessing treatment effect. The aim of this study is to evaluate the impact of symptoms of dry eye on vision-related quality of life in patients with systemic sclerosis, and to investigate the relation between clinical tests and symptoms of dry eye in these patients.

Methods

In this cross-sectional study, 45 consecutive patients with SSc were enrolled. For evaluation of the symptoms the “Ocular Surface Disease Index (OSDI)” questionnaire was applied to all patients. After that, all individuals were submitted to a full ophthalmic examination, including the following tests: tear break-up time, Schirmer I, rose bengal staining. Patients were then grouped into dry eye and non-dry eye groups with regard to the diagnosis of dry eye. Mann–Whitney test was used to compare continuous variables, whereas the Fisher exact test was used to compare categorical data between groups. Spearman’s correlation test was used to analyze the correlations between clinical tests and OSDI scores. P values?<0.05 were considered significant.

Results

Dry eye disease was diagnosed in 22 patients (48.9%). Other ocular surface abnormalities found were: blepharitis (40% of the patients), pterygium (15.6%), pinguecula (82.2%), and superficial punctate keratitis (26.7%). Among the 45 patients, 29 patients (64.4%) had symptoms of ocular surface disease. The mean OSDI score was 26.8?±?25.8 (SD). There were no statistically significant differences in OSDI scores between DED and non-DED patients. No substantive correlations were found between OSDI scores and TBUT, Schirmer I, or rose bengal staining score, and none of the observed correlations reached statistical significance.

Conclusion

Symptoms of dry eye have a moderate impact on vision-related quality of life in patients with systemic sclerosis and do not correlate well with clinical findings.