Keratograph 5M眼表综合分析仪在干眼诊断中的应用研究
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摘要
目的应用Keratograph 5M眼表综合分析仪(K5M)对比干眼病人和正常志愿者的非侵入性泪膜破裂时间(noninvasive Keratograph tear breakup time,NIKBUT)和泪河高度(tear meniscus height,TMH),探讨NIKBUT和TMH联合应用在干眼诊断中的作用。方法选取干眼病人110例,110眼(干眼组);正常志愿者108人,108眼(对照组)。所有入选受检者均完成眼表疾病评分指数(Ocular Surface Disease Index,OSDI)问卷调查;应用K5M测量TMH和NIKBUT[首次泪膜破裂时间(first noninvasive Keratograph tear breakup time,NIKBUTf)和平均泪膜破裂时间(average noninvasive Keratograph tear breakup time,NIKBUTav)];角膜荧光染色测量传统泪膜破裂时间(tear film breakup time,BUT)和角膜荧光素染色评分;SchirmerⅠ试验(SⅠt)测量泪液分泌量。比较分析2组受检者各参数,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)。结果干眼组和对照组OSDI评分、BUT、SⅠt值、角膜染色评分,差异均有统计学意义(P均<0.001)。其中干眼组和对照组的NIKBUTf值分别为(5.9±3.96)s和(8.78±4.33)s(P<0.001);NIKBUTav值分别为(8.07±4.34)s和(12.67±4.43)s(P<0.001);TMH分别为(0.22±0.06)mm和(0.28±0.09)mm(P<0.001)。ROC分析显示,NIKBUTf、NIKBUTav和TMH单独诊断干眼的曲线下面积、灵敏度、特异度分别为0.740、80%和67.59%;0.798、64.55%和83.33%;0.660、33.63%和94.44%。三参数联合诊断干眼的曲线下面积、灵敏度、特异度分别为0.829、67.3%和86.1%。结论 K5M能够有效测量干眼病人和正常志愿者眼表TMH和NIKBUT,且所测得参数两组间差异有统计学意义(P<0.05)。TMH和NIKBUT单独应用对于干眼的诊断效率欠佳,但联合参数能够明显提高诊断效率,具有实际临床应用价值。
Objective To compare the noninvasive Keratograph tear breakup time( NIKBUT) and tear meniscus height( TMH) of patients with dry eye disease( DED) and healthy control subjects using Keratograph 5M( K5M) and to investigate the role of NIKBUT and TMH in the diagnosis of DED. Methods In this prospective study,110 eyes with DED( DED group) and 108 healthy control eyes( Control group) were enrolled. All subjects completed the Ocular Surface Disease Index( OSDI) questionnaire. NIKBUT,which included the first NIKBUT( NIKBUTf) and average NIKBUT( NIKBUTav),and TMH were measured by K5 M. The fluorescein tear breakup time( BUT),corneal staining and SchirmerⅠtest were also applied. All parameters were compared between the DED and Control groups. The receiver operating characteristic curves( ROC) were plotted to distinguish DED from the normal eyes. Results There were significant difference between DED and Control group for the values of OSDI,BUT,corneal staining score and SchirmerⅠtest( all P < 0. 001). In the DED group,the NIKBUTf,NIKBUTav and TMH were( 5. 9 ± 3. 96) s,( 8. 07 ± 4. 34) s and( 0. 22 ± 0. 06) mm,respectively; while in the Control group,the values were( 8. 78 ± 4. 33) s,( 12. 67 ± 4. 43) s and( 0. 28 ± 0. 09) mm,respectively( between the two groups,all P <0. 001). For ROC analysis,the area under the curve( AUC),sensitivity and specificity were 0. 740,80% and 67. 59% for NIKBUTf;0. 798,64. 55% and 83. 33% for NIKBUTav; 0. 660,33. 63% and 94. 44% for TMH,respectively. For the combo of the three parameters,the AUC,sensitivity and specificity were 0. 829,67. 3% and 86. 1%,respectively. Conclusion Keratograph 5M offers an effective methodfor measuring NIKBUT and TMH properties of both patients with DED and healthy subjects. The three parameters exhibited significant differences between the two groups. Although the diagnostic efficiency was poor with NIKBUT or TMH alone,but the combined parameter showed a high sensitivity for the diagnosis of DED,with practical clinical application.
Objective To compare the noninvasive Keratograph tear breakup time( NIKBUT) and tear meniscus height( TMH) of patients with dry eye disease( DED) and healthy control subjects using Keratograph 5M( K5M) and to investigate the role of NIKBUT and TMH in the diagnosis of DED. Methods In this prospective study,110 eyes with DED( DED group) and 108 healthy control eyes( Control group) were enrolled. All subjects completed the Ocular Surface Disease Index( OSDI) questionnaire. NIKBUT,which included the first NIKBUT( NIKBUTf) and average NIKBUT( NIKBUTav),and TMH were measured by K5 M. The fluorescein tear breakup time( BUT),corneal staining and SchirmerⅠtest were also applied. All parameters were compared between the DED and Control groups. The receiver operating characteristic curves( ROC) were plotted to distinguish DED from the normal eyes. Results There were significant difference between DED and Control group for the values of OSDI,BUT,corneal staining score and SchirmerⅠtest( all P < 0. 001). In the DED group,the NIKBUTf,NIKBUTav and TMH were( 5. 9 ± 3. 96) s,( 8. 07 ± 4. 34) s and( 0. 22 ± 0. 06) mm,respectively; while in the Control group,the values were( 8. 78 ± 4. 33) s,( 12. 67 ± 4. 43) s and( 0. 28 ± 0. 09) mm,respectively( between the two groups,all P <0. 001). For ROC analysis,the area under the curve( AUC),sensitivity and specificity were 0. 740,80% and 67. 59% for NIKBUTf;0. 798,64. 55% and 83. 33% for NIKBUTav; 0. 660,33. 63% and 94. 44% for TMH,respectively. For the combo of the three parameters,the AUC,sensitivity and specificity were 0. 829,67. 3% and 86. 1%,respectively. Conclusion Keratograph 5M offers an effective methodfor measuring NIKBUT and TMH properties of both patients with DED and healthy subjects. The three parameters exhibited significant differences between the two groups. Although the diagnostic efficiency was poor with NIKBUT or TMH alone,but the combined parameter showed a high sensitivity for the diagnosis of DED,with practical clinical application.
引文
[1]No authors listed.The definition and classification of dry eye disease:report of the definition and classification subcommittee of the international dry eye Work Shop(2007)[J].Ocul Surf,2007,5(2):75-92.
[2]中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[3]No authors listed.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Work Shop(2007)[J].Ocul Surf,2007,5(2):93-107.
[4]No authors listed.Methodologies to diagnose and monitor dry eye disease:report of the diagnostic methodology subcommittee of the international Dry Eye Work Shop(2007)[J].Ocul Surf,2007,5(2):108-152.
[5]Mengher L S,Bron A J,Tonge S R,et al.A non-invasive instrument for clinical assessment of the pre-corneal tear film stability[J].Curr Eye Res,1985,4(1):1-7.
[6]Nichols K K,Mitchell G L,Zadnik K.The repeatability of clinical measurements of dry eye[J].Cornea,2004,23(3):272-285.
[7]Abdelfattah N S,Dastiridou A,Sadda S R,et al.Noninvasive imaging of tear film dynamics in eyes w ith ocular surface disease[J].Cornea,2015,34 Suppl 10:S48-52.
[8]Arriola-Villalobos P,Fernándezvigo J I,Díazvalle D,et al.Assessment of low er tear meniscus measurements obtained w ith keratograph and agreement w ith fourier-domain optical-coherence tomography[J].Br J Ophthalmol,2015,99(8):1120-1125.
[9]Wang X,Lu X,Yang J,et al.Evaluation of dry eye and meibomian gland dysfunction in teenagers w ith myopia through noninvasive keratograph[J].J Ophthalmol,2016,2016:6761206
[10]Braun R J,King-Smith P E,Begley C G,et al.Dynamics and function of the tear film in relation to the blink cycle[J].Prog Retin&Eye Res,2015,45(10):132-164.
[11]Uchino M,Nishiwaki Y,Michikawa T,et al.Prevalence and risk factors of dry eye disease in Japan:Koumi study[J].Ophthalmology,2011,118(12):2361-2367.
[12]熊婵,刘珍凯,纪开宝,等.视屏终端的使用对人泪膜及眼表的影响及非侵入性眼表综合分析仪的应用价值[J].中华实验眼科杂志,2016,34(5):443-447.
[13]Elliott M,Fandrich H,Simpson T,et al.Analysis of the repeatability of tear break-up time measurement techniques on asymptomatic subjects before,during and after contact lens w ear[J].Cont Lens&Anterior Eye,1998,21(4):98-103.
[14]Savini G,Prabhawasat P,Kojima T,et al.The challenge of dry eye diagnosis[J].Clin Ophthalmol,2008,2(1):31-55.
[15]伍志琴,杨燕宁,袁静,等.非侵入性眼表综合分析仪在指导干眼病人个体化治疗中的应用价值[J].国际眼科杂志,2016,16(3):572-574.
[16]Holly F J.Physical chemistry of the normal and disordered tear film[J].Trans Ophthalmol Soc U K,1985,104(Pt4):374-380.
[17]Ibrahim O M,Dogru M,Takano Y,et al.Application of visante optical coherence tomography tear meniscus height measurement in the diagnosis of dry eye disease[J].Ophthalmology,2010,117(10):1923-1929.
[18]Altan-Yaycioglu R,Sizmaz S,Canan H,et al.Optical coherence tomography for measuring the tear film meniscus:correlation w ith schirmer test and tear-film breakup time[J].Curr Eye Res,2013,38(7):736-742.
[19]Hong J,Sun X,Wei A,et al.Assessment of tear film stability in dry eye w ith a new ly developed keratograph[J].Cornea,2013,32(5):716-721.
[20]Mainstone J C,Bruce A S,Golding T R.Tear meniscus measurement in the diagnosis of dry eye[J].Curr Eye Res,1996,15(6):653-661.
[21]Koh S,Ikeda C,Watanabe S,et al.Effect of non-invasive tear stability assessment on tear meniscus height[J].Acta Ophthalmol,2015,93(2):e135-e139.
[22]Qiu X,Gong L,Sun X,et al.Age-related variations of human tear meniscus and diagnosis of dry eye w ith Fourier-domain anterior segment optical coherence tomography[J].Cornea,2011,30(5):543-549.
[23]Cui L,Shen M,Wang J,et al.Age-related changes in tear menisci imaged by optical coherence tomography[J].Optom Vis Sci,2011,88(10):1214-1219.
[24]Best N,Drury L,Wolffsohn J S.Clinical evaluation of the oculus keratograph[J].Cont Lens Anterior Eye,2012,35(4):171-174.
[25]康龙丹,刘岩.人工泪液和临时性泪道塞治疗干眼的临床疗效观察[J].中国医科大学学报,2015,44(10):930-931.
[26]祁媛媛,赵少贞,黄悦,等.新型非侵入性眼表综合分析仪在干眼评估中的应用价值[J].中华实验眼科杂志,2015,33(2):165-169.
[27]Mengher L S,Bron A J,Tonge S R,et al.Effect of fluorescein instillation on the pre-corneal tear film stability[J].Curr Eye Res,1985,4(1):9-12.
[28]Cho P,Douthwaite W.The relation between invasive and noninvasive tear break-up time[J].Optom Vis Sci,1995,72(1):17-22.
[2]中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[3]No authors listed.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Work Shop(2007)[J].Ocul Surf,2007,5(2):93-107.
[4]No authors listed.Methodologies to diagnose and monitor dry eye disease:report of the diagnostic methodology subcommittee of the international Dry Eye Work Shop(2007)[J].Ocul Surf,2007,5(2):108-152.
[5]Mengher L S,Bron A J,Tonge S R,et al.A non-invasive instrument for clinical assessment of the pre-corneal tear film stability[J].Curr Eye Res,1985,4(1):1-7.
[6]Nichols K K,Mitchell G L,Zadnik K.The repeatability of clinical measurements of dry eye[J].Cornea,2004,23(3):272-285.
[7]Abdelfattah N S,Dastiridou A,Sadda S R,et al.Noninvasive imaging of tear film dynamics in eyes w ith ocular surface disease[J].Cornea,2015,34 Suppl 10:S48-52.
[8]Arriola-Villalobos P,Fernándezvigo J I,Díazvalle D,et al.Assessment of low er tear meniscus measurements obtained w ith keratograph and agreement w ith fourier-domain optical-coherence tomography[J].Br J Ophthalmol,2015,99(8):1120-1125.
[9]Wang X,Lu X,Yang J,et al.Evaluation of dry eye and meibomian gland dysfunction in teenagers w ith myopia through noninvasive keratograph[J].J Ophthalmol,2016,2016:6761206
[10]Braun R J,King-Smith P E,Begley C G,et al.Dynamics and function of the tear film in relation to the blink cycle[J].Prog Retin&Eye Res,2015,45(10):132-164.
[11]Uchino M,Nishiwaki Y,Michikawa T,et al.Prevalence and risk factors of dry eye disease in Japan:Koumi study[J].Ophthalmology,2011,118(12):2361-2367.
[12]熊婵,刘珍凯,纪开宝,等.视屏终端的使用对人泪膜及眼表的影响及非侵入性眼表综合分析仪的应用价值[J].中华实验眼科杂志,2016,34(5):443-447.
[13]Elliott M,Fandrich H,Simpson T,et al.Analysis of the repeatability of tear break-up time measurement techniques on asymptomatic subjects before,during and after contact lens w ear[J].Cont Lens&Anterior Eye,1998,21(4):98-103.
[14]Savini G,Prabhawasat P,Kojima T,et al.The challenge of dry eye diagnosis[J].Clin Ophthalmol,2008,2(1):31-55.
[15]伍志琴,杨燕宁,袁静,等.非侵入性眼表综合分析仪在指导干眼病人个体化治疗中的应用价值[J].国际眼科杂志,2016,16(3):572-574.
[16]Holly F J.Physical chemistry of the normal and disordered tear film[J].Trans Ophthalmol Soc U K,1985,104(Pt4):374-380.
[17]Ibrahim O M,Dogru M,Takano Y,et al.Application of visante optical coherence tomography tear meniscus height measurement in the diagnosis of dry eye disease[J].Ophthalmology,2010,117(10):1923-1929.
[18]Altan-Yaycioglu R,Sizmaz S,Canan H,et al.Optical coherence tomography for measuring the tear film meniscus:correlation w ith schirmer test and tear-film breakup time[J].Curr Eye Res,2013,38(7):736-742.
[19]Hong J,Sun X,Wei A,et al.Assessment of tear film stability in dry eye w ith a new ly developed keratograph[J].Cornea,2013,32(5):716-721.
[20]Mainstone J C,Bruce A S,Golding T R.Tear meniscus measurement in the diagnosis of dry eye[J].Curr Eye Res,1996,15(6):653-661.
[21]Koh S,Ikeda C,Watanabe S,et al.Effect of non-invasive tear stability assessment on tear meniscus height[J].Acta Ophthalmol,2015,93(2):e135-e139.
[22]Qiu X,Gong L,Sun X,et al.Age-related variations of human tear meniscus and diagnosis of dry eye w ith Fourier-domain anterior segment optical coherence tomography[J].Cornea,2011,30(5):543-549.
[23]Cui L,Shen M,Wang J,et al.Age-related changes in tear menisci imaged by optical coherence tomography[J].Optom Vis Sci,2011,88(10):1214-1219.
[24]Best N,Drury L,Wolffsohn J S.Clinical evaluation of the oculus keratograph[J].Cont Lens Anterior Eye,2012,35(4):171-174.
[25]康龙丹,刘岩.人工泪液和临时性泪道塞治疗干眼的临床疗效观察[J].中国医科大学学报,2015,44(10):930-931.
[26]祁媛媛,赵少贞,黄悦,等.新型非侵入性眼表综合分析仪在干眼评估中的应用价值[J].中华实验眼科杂志,2015,33(2):165-169.
[27]Mengher L S,Bron A J,Tonge S R,et al.Effect of fluorescein instillation on the pre-corneal tear film stability[J].Curr Eye Res,1985,4(1):9-12.
[28]Cho P,Douthwaite W.The relation between invasive and noninvasive tear break-up time[J].Optom Vis Sci,1995,72(1):17-22.