Oculus眼表综合分析仪测量LASIK术后干眼患者非侵入性泪液功能指标与干眼症状和体征之间的相关性分析

目的　探讨Ｏｃｕｌｕｓ眼表综合分析仪测量准分子激光原位角膜磨镶术（ｌａｓｅｒｉｎｓｉ-ｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）术后干眼患者的非侵入性泪液功能指标与干眼症状、体征的相关性。方法　选择鄂州市中心医院２０１４年９月至１２月行ＬＡＳＩＫ且术后１个月被诊断为干眼的患者４０例（４０眼），Ｏｃｕｌｕｓ眼表综合分析仪测量非侵入性首次泪膜破裂时间（ｎｏｎ-ｉｎｖａｓｉｖｅｆｉｒｓｔｔｅａｒｆｉｌｍｂｒｅａｋ-ｕｐｔｉｍｅ，ＮＩＢ-ＵＴｆ）、非侵入性平均泪膜破裂时间（ｎｏｎ-ｉｎｖａｓｉｖｅａｖｅｒａｇｅｔｅａｒｆｉｌｍｂｒｅａｋ-ｕｐｔｉｍｅ，ＮＩＢＵＴａｖ）、Ｏｃｕｌｕｓ自动干眼分级、下泪河高度（ｌｏｗｅｒｔｅａｒｍｅｎｉｓｃｕｓｈｉｇｈｔ，ＬＴＭＨ）；基础泪液分泌（ＳｃｈｉｒｍｅｒⅠ Ｔｅｓｔ，ＳⅠＴ）、角膜荧光素染色（ｃｏｒｎｅａｌｆｌｕｏｒｅｓｃｅｉｎｓｔａｉｎｉｎｇ，ＣＦＳ）评分、患者干眼主观症状评分。采用Ｓｐｅａｒｍａｎ秩相关分析ＮＩＢＵＴｆ、ＮＩＢＵＴａｖ、Ｏｃｕｌｕｓ自动干眼分级、ＬＴＭＨ与ＳⅠＴ、ＦＳ、干眼主观症状评分之间的关系。结果　ＮＩＢＵＴｆ、ＮＩＢＵＴａｖ与Ｏｃｕｌｕｓ自动干眼分级均呈负相关（ｒ＝－０．４３０，Ｐ＝０．００６；ｒ＝－０．７４７，Ｐ＝０．０００）；ＳⅠＴ与ＮＩＢＵＴｆ、ＮＩＢＵＴａｖ、ＬＴＭＨ均呈正相关（ｒ＝０．４５９，Ｐ＝０．００３；ｒ＝０．３９４，Ｐ＝０．０１２；ｒ＝０．７３３，Ｐ＝０．０００），ＳⅠＴ与Ｏｃｕｌｕｓ自动干眼分级无相关性（ｒ＝－０．２５９，Ｐ＝０．１０７）；ＣＦＳ评分与ＮＩＢＵＴａｖ、ＬＴＭＨ均呈负相关（ｒ＝－０．４６６，Ｐ＝０．００２；ｒ＝－０．６８７，Ｐ＝０．０００），ＣＦＳ评分与ＮＩＢＵＴｆ、Ｏｃｕｌｕｓ自动干眼分级均无相关性（ｒ＝－０．１８９，Ｐ＝０．２４４；ｒ＝０．３０１，Ｐ＝０．０５９）；干眼主观症状评分与ＮＩＢＵＴｆ、ＮＩＢＵＴａｖ均呈负相关（ｒ＝－０．５３０，Ｐ＝０．０００；ｒ＝－０．７００，Ｐ＝０．０００），与Ｏｃｕｌｕｓ自动干眼分级呈正相关（ｒ＝０．６２３，Ｐ＝０．０００）、与ＬＴＭＨ无明显相关性（ｒ＝－０．２４３，Ｐ＝０．１３０）。结论　Ｏｃｕｌｕｓ眼表综合分析仪能客观地测量非侵入性泪液功能指标，与干眼其他指标存在相关性，可作为辅助ＬＡＳＩＫ术后干眼诊断和随访的有效工具。

Correlation between non-invasive tear function indicators and dry eye symptoms,signs in dry eye patients after LASIK by Oculus KeratograPh5M

Objective To evaluate the correlation between non-invasive tear function indicators and dry eye signs , symptoms in dry eye patients after LASIK by Oculus Keratograph5M. Methods Forty cases ( 40 eyes) diagnosed as dry eye at I month after LASIK in Ezhou Central Hospital from September to December 2014 were chosen. Non-invasive first tear film break-up time ( NIBUTf ) , non-invasive average tear film break-up time ( NIBUTav ) . non-invasive lower tear meniscus height ( LTMH ) , oculus automatic dry eye classification were measured with Oculus Keratograph5M, and Schirmer I test ( S IT ) . corneal fluorescein staining score ( CFS ) , dry eye subjective symptom scores were performed in all cases. The correlations analysis between the noninvasive tear function indicators and S IT. FS , dry eye subjective symptom scores were performed by Spearman rank correlation. Results Both NIBUTf and NIBUTav showed negative correlation with Oculus automatic dry eye classification ( r = - 0. 430 . P = 0. 006 ; r = - 0. 747 ,P = 0. 000 ) ; S IT and NIBUTf , NIBUTav. LTMH showed positive correlation( r = 0. 459 .P = 0. 003 ;r = 0. 394 ,P = 0. 012 ; r = 0. 733 ,P = 0. 000 ) . but there was no correlation with oculus automatic dry eye classification ( r = - 0. 259, P = 0. 107) ;FS and NIBUTav.LTMH showed negative correlation ( r = - 0. 466 ,P = 0. 002 ; r = - 0. 687 .P = 0. 000 ) , but there was no correlation with NIBUTf and oculus automatic dry eye classification( r = - 0. 189 .P = 0. 244 ; r = 0. 301 ,P = 0. 059) ; Both NIBUTf and NIBUTav showed negative correlation with dry eye subjective symptom scores ( r = - 0. 530 .P = 0. 000 ;r = - 0. 700 ,P = 0. 000 ) , but showed s good positive correlation with oculus automatic dry eye classification ( r = 0. 623 ,P = 0. 000) . There was no correlation between dry eye subjective symptom scores and LTMH ( r = - 0. 243 .P = 0. 130) . Conclrision Oculus Keratograph5M can objectively measure non-rnvasive tear function indicators .which are associated with dry eye symptoms and signs , can be as a effective instrument for auxiliary diagnosis and follow-up of dry eye after LASIK.