妊娠期糖尿病患者眼表相关指标的临床分析

目的：应用Keratogragh 5M眼表分析仪对比妊娠期糖尿病孕妇与正常孕妇眼表相关指标。

方法：选择妊娠期糖尿病患者45例45眼及正常孕妇48例48眼作为研究对象。所有对象完成眼表疾病指数(OSDI)问卷调查对眼表进行评分,应用Keratogragh 5M测量泪河高度(TMH)、非侵入性平均泪膜破裂时间(NIKBUTav)、眼红指数、睑板腺缺失评分。得出结果后对两组各项指标进行比较。

结果：妊娠期糖尿病组及正常孕妇组的OSDI、TMH、NIKBUTav、眼红指数及睑板腺缺失评分均无差异(P>0.05)。其中OSDI分别为8.02±4.25、7.50±4.28分(P=0.557),TMH值分别为0.22±0.05、0.20±0.04mm(P=0.158),NIKBUTav值分别为8.01±2.15、8.02±1.53s(P=0.971)。

结论：妊娠期糖尿病组与正常孕妇组眼表各项指标差异均无统计学意义,妊娠期糖尿病对眼表相关指标没有明显的影响,可能与血糖控制良好有关。     

Increased Tear Film Osmolarity in Systemic Lupus Erythematosus

Purpose: To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). Methods: A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear ?lm break-up time (BUT), Schirmer’s test, and Ocular Surface Disease Index (OSDI). Results: The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer’s test score and the BUT value (r = ?0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = ?0.182 p = 0.183). Conclusions: This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.     

Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction

Purpose: To evaluate the results of tear functions in acne rosacea.

Methods: This prospective study includes 64 eyes of 32 acne rosacea patients without blepharitis and meibomian gland dysfunction and 90 eyes of 45 patients as control group. Tear functions of all were evaluated with ocular surface disease index (OSDI) questionnaire, and measurements of tear osmolarity were performed by using TearLab, Schirmer I tests without anesthesia and fluorescein tear break-up time (TBUT).

Results: The mean Schirmer test result was 12.53 ± 6.54 in study group and 16.21 + 7.52 mm/5 min in control group (p = 0.28). The mean TBUT in study group was 8.21 ± 4.01 and in control group was 18.03 ± 6.45 s (p = 0.02). Mean tear osmolarity in study group was 304.77 ± 15.59and in control group was 275.23 + 28.52 mOsms/L (p = 0.03). Mean OSDI score in study group was 27.51 ± 16.73 and was 18.15 ± 7.05 in control group (p = 0.38).

Conclusions: Our study demonstrated lower dry eye tests before the appearance of clinical signs of meibomian gland disease in acne rosacea.     

The relation between tear film tests in patients with dry eye disease

PURPOSE: The purpose of this report was to investigate the relation between dry eye diagnostic tests. METHODS: Dry eye patients were enrolled to complete a clinical examination, including the following dry eye tests: a meibomian gland evaluation, tear meniscus height, fluorescein tear breakup time, fluorescein staining of the cornea, the Schirmer 1 test, the phenol red thread test, and rose bengal staining of the conjunctiva. Statistical analyses, including correlation coefficients, the Wilcoxon sign rank test, chi-square test, and logistic regression were used to address the relation between these clinical tests of dry eye. RESULTS: There was a strong relation between the Schirmer test and fluorescein staining in all four statistical analyses. Similarly, there was also a strong relation between the phenol red thread test and both fluorescein and rose bengal staining. Finally, the results of the Schirmer test were associated with the tear breakup time test in three of four analyses. CONCLUSIONS: The results indicate that tests of aqueous deficiency (volume or production) are associated with ocular surface desiccation. This important relation should be recognized when choosing dry eye tests as outcomes in clinical trials and epidemiological studies.     

Clinical Objective Dry Eye Tests in a Population of Tannery Workers in North India

Purpose: To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers.

Methods: In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey.

Results: All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p < 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p < 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p < 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p < 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p < 0.0001).

Conclusion: Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.     

Tear Film Break-up Time Evaluated by Real-Time Hartmann-Shack Wavefront Sensing

Purpose

To develop a novel method for measuring tear break-up time (BUT) by continuously measuring higher order wavefront aberrations using a Hartmann-Shack (H-S) aberrometer.

Methods

Wavefront aberrations up to the sixth order for a 4-mm pupil were measured in six eyes of six normal subjects using an H-S aberrometer. The aberrometry was performed once every second for up to 50?s under topical anesthesia. The sequence of the points was divided into two stages, and the BUT was defined as the wavefront border of the stages (WFBUT). The WFBUT was compared with the BUT by the conventional fluorescein method (FLBUT) or by the disruption of placid-ring images (PLBUT).

Results

In three eyes, the WFBUT (average, 10.9 ± 1.1?s) was shorter than the PLBUT (average, 17.5 ± 2.5?s), while in the other three eyes the WFBUT (average, 21.5 ± 2.2?s) was longer than PLBUT (average, 8.1 ± 2.2?s). The FLBUT was shorter than WFBUT or PLBUT in most cases.

Conclusions

The tear break-up time measured by H-S aberrometer may be used as a practical measure of tear break-up.?Jpn J Ophthalmol 2006;50:85–89 © Japanese Ophthalmological Society 2006     

睑缘炎所致泪膜损害23例

目的探讨睑缘炎对泪膜的损害作用。方法对23例严重睑缘炎患者进行详细裂隙灯检查、泪膜破裂时间、泪液分泌试验测定及角膜上皮荧光素染色。观察经药物治疗后上述各项的改变。结果23例患者睑缘充血、不规则,睫毛根部及睑板腺开口处黄色分泌物及痂皮附着,泪膜破裂时间缩短,角膜弥漫着色,泪液分泌试验在正常范围。结论睑缘炎引起脂质分泌减少及成分异常,破坏泪膜稳定性,导致蒸发过强型干眼。     

Tear ferning and other lacrimal tests in normal persons of different ages

Summary We investigated in normal persons of different ages ranging from 4 months to 85 years the frequency of different ferning types as well as the results of the Schirmer I test, break-up time and tear protein profile. With increasing age, ferning types of higher degree were significantly more frequent. Furthermore, a correlation was found between the ferning test and low Schirmer test values (p < 0.05) as well as break-up time (p < 0.1). No correlation exists between ferning the test and tear protein pattern. These results indicate that tear ferning is independent from single tear proteins but in correlation with secreted watery volume and plays some role in tear film stability. Furthermore, these normal values of ferning and protein pattern can be used as references for different ages.     

糖尿病泪液功能和眼表面变化

目的:探讨糖尿病患者泪液功能和眼表面失调及其影响因素。方法:研究60例120眼非胰岛素依赖型患者,根据病程将其分为A,B,C3个组:A组患者病程<5a,B组患者病程5～9a,C组患者病程≥10a;40例80眼无糖尿病同年龄段者设为对照组。所有研究者均观察角膜荧光素染色、泪膜破裂时间及Schirmer试验;对糖尿病组及对照组各20眼行结膜印记细胞学检查。结果:糖尿病组泪膜破裂时间较对照组短(u=13.54,P<0.01),角膜荧光素染色阳性细胞检出率高于对照组(χ2=52.21,P<0.01),泪液分泌试验较对照组少(t=2.05,P<0.05)。B,C组泪膜破裂时间较A组短,泪液分泌亦减少。结膜印记细胞学检查糖尿病组结膜上皮细胞异常较多,杯状细胞数较少。结论:糖尿病患者是干眼症的易患人群;糖尿病患者的眼表疾病以泪液的质和量的失调,鳞状上皮化生、杯状细胞减少为特征。泪膜破裂时间、Schirmer试验、角膜荧光素染色检查可作为糖尿病患者的眼科常规检查。     

干燥综合征泪液功能和眼表面变化

目的：研究不同发病年龄组及不同病程组的原发干燥综合征(Sjögren's syndrome,SS)眼部表现的差异,以探讨SS患者的泪液功能和角结膜状况及其影响因素。

方法：回顾性分析SS患者80例160眼,根据病程将其分为3组：A组患者病程≤1a,B组患者病程1～2a,C组患者病程>2a,同时根据年龄将其分4个组：A组14～30岁,B组31～45岁,C组46～60岁,D组61～75岁,对比分析各组角膜荧光素染色(cornea fluorescein,CF)、泪膜破裂时间(break-up time,BUT)及Schirmer试验(Schirmer Ⅰ test,SⅠt)检查以及干眼症出现情况。

结果：SS患者干眼症患病率为38%,明显高于普通人群,干眼症患病率随发病年龄的增大(χ²=10.66,P=0.014)及病程的延长(χ²=20.127,P=0.000)而增加。SⅠt随发病年龄的增大(H=2.575,P=0.462)及病程的延长(H=7.356,P=0.025)而减少,BUT随发病年龄的增大(H=11.932,P=0.008)及病程的延长(H=12.969,P=0.002)而缩短,CF随发病年龄的增大(H=14.068,P=0.003)及病程的延长(H=16.060,P=0.000)而加重。

结论：SS患者易继发干眼症。SS患者的眼表改变表现为泪液的质和量的失调,泪膜稳定性下降,泪液分泌量下降,角膜荧光素着色,上述变化与发病年龄和病程成正相关。BUT、SⅠt、CF检查有必要作为SS患者的眼科常规检查。     

Short tear film breakup time-type of dry eye in India

Purpose:The aim of this study was to describe the clinical characteristics and risk factors of short tear film break-up time (TBUT) type of dry eye disease and compare it with other types of dry eye diseases.Methods:This cross-sectional study included 570 patients (≥ 20 years) from the outpatient department using systematic random sampling.Results:The age-adjusted prevalence of short TBUT type of dry eye disease was 5.4% (95% confidence interval: 3.2–6.8%). There was no difference (P > 0.05) between the total and subscale scores of the Ocular Surface Disease Index^® questionnaire between patients with short TBUT and those with aqueous tear deficiency. Both these groups differed significantly (P < 0.05) in the findings of TBUT, Schirmer I test, and Lissamine green staining score. The common symptoms in patients with short TBUT type of dry eye disease were eye fatigue (25.4%), heaviness in the eye (19.7%), and an uncomfortable sensation (14.1%). The symptoms in the aqueous tear deficiency group were light sensitivity (28.2%), dryness (19.2%), burning (13.0%), foreign body sensation (12.8%), and blurring of vision (14.1%). The risk factors associated with short TBUT type of dry eye disease were the presence of meibomian gland dysfunction (odds ratio: 3.759 [95% confidence interval: 2.135–6.618], P < 0.0001) and female sex [odds ratio: 1.954 (95% confidence interval: 1.042–3.667), P = 0.037].Conclusion:Patients with short TBUT type of dry eye disease have symptom severity similar to aqueous tear-deficient dry eyes, but the pattern is different. The finding of this type of dry eye disease in India indicates its global presence, and ophthalmologists should consider it in their differential diagnoses.     

泪膜与眼表微环境的研究进展

泪膜覆盖眼表,是眼表微环境的重要组成部分,其稳态失衡可以造成眼表其他细胞和组织结构与功能异常,从而加重眼表疾病的发生和发展。笔者旨在对泪膜与眼表微环境中其他的成分包括眼表上皮、角膜基质、角膜神经和眼表微生物群的作用方面进行综述,以期为眼表疾病的发病机制研究及诊疗提供新的思路。     

干眼症症状与体征的相关性研究

目的分析干眼症患者的主观症状与客观检查的相关性。方法选取2007年12月—2008年8月就诊于天津医科大学眼科中心门诊的干眼症患者126例252眼,检查前均取得患者书面同意。通过检查视力、泪膜干涉仪检查、泪液分泌试验（STⅠ）、干眼症问卷调查,并在15min后用裂隙灯检查眼前节,进行泪膜破裂时间（BUT）及荧光素（FL）染色检查。采用Spearman秩相关研究分析干眼症症状与体征间的关系。结果干眼症患者最常见的症状是视疲劳（85.7%）、干涩（75.4%）、视力波动（73.8%）、眼痒（65.9%）以及异物感（66.7%）。干眼症患者分泌物增多与STⅠ呈正相关（r=0.208,P=0.020）,流泪症状与STⅠ结果呈正相关（r=0.311,P=0.000）,眼痛与BUT呈负相关（r=-0.197,P=0.027）,眼红与FL染色呈正相关（r=0.227,P=0.011）,异物感与FL染色呈正相关（r=0.251,P=0.005）。其余干眼症症状与ST、BUT、FL染色无明显相关性（P〉0.05）,所有干眼症症状均与泪膜干涉图像分级无明显相关（P〉0.05）。结论干眼症患者症状复杂,干眼症症状与体征的相关性较差。     

马来、中国、印度和尼日利亚四个不同国家人群的泪膜测量分析

目的:比较马来、中国、印度和尼日利亚4个不同人群的无创性泪膜破裂时间(NIBUT)、泪膜破裂时间(TBUT)、基础泪液分泌量(BTS)和眨眼频率。方法:共纳入120例(男性61例,女性59例)年龄20~39岁健康受试者,其中30例马来人,30例中国人,31例印度人,29例尼日利亚人。根据McMonnies调查问卷和临床检查,挑选了健康受试者。选取受试者右眼评估NIBUT、TBUT、BTS,及眨眼频率。结果:四组人群中NIBUT、TBUT、BTS,及眨眼频率具有显著差异(P=0.018,P=0.001,P=0.011,P=0.004)。不同民族人群性别间NIBUT、TBUT、BTS和眨眼频率差异无统计学意义。相较于其他三组,印度人NIBUT(10±6s),TBUT(7±5s)和BTS(20±20 mm)中位数较高,中国人NIBUT(7.5±4s)和TBUT(4±2s)中位数较低,马来人BTS为9.5±16mm。眨眼频率与NIBUT、TBUT、BTS间无显著相关(r=-0.119,P=0.195),(r=-0.086,P=0.352),(r=-0.123,P=0.180)。结论:研究体现了四个不同国家人群间泪膜测量值的差异性。     

The Precorneal Tear Film as a Fluid Shell: The Effect of Blinking and Saccades on Tear Film Distribution and Dynamics

We conducted a series of experiments to elucidate the behavior of the human precorneal tear film (PCTF) during blinking and horizontal and vertical saccades. Methodology included video-interferometry with subsequent image cross-correlation (tear film lipid layer [TFLL]) and video-microscopy (mucoaqueous subphase [MAS]). We observed that the TFLL interference pattern deteriorates rapidly with successive blinks and degrades slowly with repeated horizontal saccades during blink suppression when dark arcs of thinning appear in the fluorescein-stained PCTF. Furthermore, after full downgaze and a return to the primary position, a transient horizontal bright band appears, deep to the spreading TFLL. It may be followed by local disturbances in the interference pattern. Two horizontal dark bands form in the stained PCTF after the return saccade. PCTF disruption may occur below the lower band during blink suppression. We concluded that shearing during horizontal saccades is insufficient to disturb the tear film structure greatly. The MAS and TFLL move together as a fluid shell. The dark arcs/bands are caused by meniscus-induced thinning, imprinted onto the PCTF at the lid margin. Their stability during blink suppression suggests that the MAS has gel-like properties. The horizontal bright bands are probably due to transient corneal indentation in downgaze. In downgaze, the disturbance of the TFLL and MAS below the dark bands is possibly due to shearing across the MAS in the return phase. This could cause desiccating stress in everyday activities, such as working at a computer.     

Vitamin D Replacement Improves Tear Osmolarity in Patients with Vitamin D Deficiency

Background: Vitamin D deficiency is a common health problem worldwide. Many parts of the human eye, including the epithelium of the cornea, lens, ciliary body, and retinal pigment epithelium, as well as the corneal endothelium, ganglion cell layer, and retinal photoreceptors, contain vitamin D receptor (VDR). Dry eye is also a common health problem. An adequate tear film is required for maintaining health and function of the eye. Tear hyperosmolarity is considered to be the cause of ocular surface inflammation, symptoms, and tissue damage. It is well-documented that vitamin D has an anti-inflammatory action. We aimed to investigate the effect of vitamin D replacement on tear osmolarity in patients with vitamin D deficiency. Methods: A total of 44 patients (38 females, six males, mean age:43.5 ± 12.8 years) with vitamin D deficiency currently managed by the Endocrinology and Metabolism Department of Diskapi Training and Research Hospital in Turkey were enrolled in the study. Patients were given 50,000 units of 25(OH)D₃ intramuscularly, once weekly, over a period of eight weeks. All of the patients underwent tear function osmolarity (TFO) measurement initially and eight weeks after vitamin D replacement. Demographic, anthropometric, and biochemistry data of patients were recorded. Results: The mean TFO was significantly decreased (313.7 ± 17.3 mOsm/L; 302.7 ± 14.2 mOsm/L, p<0.001) at the end of the second month; 25(OH)D₃ concentrations increased from 8.3 ± 3.5 ng/mL to 68.8 ± 22.3 ng/mL (p<0.001). The mean levels of hsCRP, FPG, P were 2.5 ± 2.5 mg/L, 5.09 ± 0.48 mmol/L, 1.06 ± 0.16 mmol/L initially, and 3.8 ± 5.9 mg/L, 5.11 ± 0.68 mg/dL, 1.09 ± 0.16 mmol/L after vitamin D replacement, respectively (p>0.05). The mean Ca level was 2.37 ± 0.07 mmol/L initially and 2.35 ± 0.07 mmol/L after vitamin D replacement (p<0.05). The change of TFO was negatively correlated with the variation of 25(OH)D₃ before and after replacement in patients with dry eye disease (r=–0.390, p=0.049). Conclusions: As a consequence of the presence of VDR and 1α-hydroxylase in different parts of the eye, vitamin D replacement improves tear hyperosmolarity that is considered to be induced by ocular surface inflammation.     

Transpupillary thermotherapy – introduction

An accurate measurement of tear production is clinically important in the diagnosis and monitoring of dry eye conditions. Re-examination of the results of Schirmer test indicated that the rate of tear secretion decreased with advancing age. Fluorophotometry revealed that the tear turnover rate also decreased with age. Then reappraisal was made on the clinical tests for dry eye syndrome. The non-invasive tear film breakup time (NIBUT) showed a resonable level of accuracy with a cut-off value of 5 seconds (sensitivity 95.9% and specificity 90.8%). The concentration of lactoferrin showed an optimal level of accuracy with a cut-off value of 1.1 mg/ml (sensitivity 79.4% and specificity 78.3%). A study of the ocular surface area revealed that the decrease of ocular surface area was related to the values of NIBUT in normal subjects younger than 50 years of age. The present findings suggested that a combination of these clinical tests was needed for the diagnosis of dry eye syndrome.     

慢性肾功能衰竭患者泪液分泌及泪膜稳定性的研究

目的:探讨慢性肾功能衰竭(chronic renal failure,CRF)患者泪液分泌及泪膜稳定性的变化。方法:对48例96眼慢性肾衰患者眼及48例96眼正常人眼进行比较研究,观察指标包括Schirmer试验、泪膜破裂时间(BUT)和角膜荧光素染色情况。结果:CRF组Schirmer试验结果为10.17±2.19mm,泪膜破裂时间(BUT)为8.11±2.08s,均低于对照组,差异有统计学意义(t=-11.103,P<0.01;t=-10.807,P<0.01)。角膜荧光素染色阳性率12.5%(12/96),高于对照组,差异有统计学意义(χ2=7.705,P<0.01)。结论:慢性肾功能衰竭患者泪液分泌减少,泪膜稳定性较差,易患干眼症。     

Tear film measurements in four different ethnic groups: Malay, Chinese, Indian and Nigerian

AIM: To compare the non-invasive tear film break-up time (NIBUT), tear break up time (TBUT), basal tear secretion (BTS) and blink rate in four ethnic groups: Malay, Chinese, Indian and Nigerian. METHODS: Totally 120 healthy (61 males and 59 females) subjects (without dry eye symptoms and ocular surface disorder) with the age 20 to 39 years were recruited; 30 were Malays, 30 were Chinese, 31 were Indians and 29 were Nigerians. Based on McMonnies questionnaire and clinical examination, normal subjects were selected. NIBUT, TBUT, BTS were assessed in only one eye (right) of each subject and blink rate was also assessed. RESULTS: There was significant difference in the NIBUT, TBUT, BTS and blink rate among 4 different ethnic groups (P=0.018, 0.001, 0.011, and 0.004 respectively). No statistically significant difference of NIBUT, TBUT, BTS and blink rate was found between the genders among different ethnic groups. Indian had higher median for NIBUT (10±6s), TBUT (7±5s) and BTS (20±20 mm) than other races. Chinese had lower median for NIBUT (7.5±4s) and TBUT (4±2s) while Malay had for BTS (9.5±16 mm) among the groups. There was no significant correlation of blink rate with NIBUT (r=-0.119, P=0.195), TBUT (r=-0.086, P=0.352), and BTS (r=-0.123, P=0.180) respectively. CONCLUSION: The tear-film measurement values are variability in four ethnic groups.     

放射科技师泪膜功能的研究

目的探讨放射科技师泪膜功能。方法前瞻性研究，放射科技师及对照组各34例，分别行干眼症状询问、泪膜破裂时间测定（BUT）、角膜荧光素染色（FIS）、基础泪液分泌实验（SIt）、睑板腺功能检查。结果病例组泪膜破裂时间、基础泪液分泌试验的结果及其异常的比率与对照组比较，差异有统计学意义（P〈0．05），病例组出现干眼症状的比率高于对照组（P〈0．05），角膜荧光素染色阳性、睑板腺功能障碍的比率与对照组比较，差异无统计学意义（P〉0．05），专业工作年限与眼干症状、泪膜破裂时间、角膜荧光素染色、睑板腺功能障碍、基础泪液分泌试验之间无相关性。结论放射科技师易发生泪膜功能及泪腺分泌异常，易出现干眼症状。