非侵入性眼表综合分析仪及Lipiview眼表面干涉仪评估儿童干眼的特点
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摘要
目的利用非侵入性眼表综合分析仪及Lipiview眼表面干涉仪评估儿童干眼的特点。方法选取2017年1月至8月于天津医科大学眼科医院第一次确诊为干眼的儿童98例(186眼),完成病史及眼表疾病指数(ocular surface disease index,OSDI)问卷后进行裂隙灯、泪膜破裂时间(tear film brek-up time,BUT)、泪液分泌试验(SchirmerⅠtest,SⅠT)评估、非侵入性眼表综合分析仪及Lipiview眼表面干涉仪检查。结果本组中159眼的BUT <5 s,30眼的SIt <5 mm。OSDI[13. 63(9. 09～15. 91)分]与SⅠT[(14. 6±8. 7) mm]无相关性(r=-0. 119,P=0. 259);与BUT[3. 00(2. 00～5. 00) s]无相关性(r=0. 099,P=0. 354)。第一次非侵入性泪膜破裂时间(first noninvasive tear film break-up time,NITBUT),平均非侵入性泪膜破裂时间(average noninvasive tear film break-up time,NITBUTav)与OSDI均呈正相关性,NIBUT与NIBUTav呈高度正相关性(均为P <0. 05)。NIBUT、NIBUTav与BUT均无相关性(r=0. 112,P=0. 059; r=0. 159,P=0. 455)。泪膜脂质层厚度(lipid layer thickness,LLT)、LLT最大值与NIBUTav呈正相关性;不完全眨眼比例与NIBUTav呈负相关性(均为P <0. 05);其余指标与OSDI和NITBUTav无相关性。LLT、LLT最大值、LLT最小值与睑板腺缺失评分均无相关性(r=-0. 083、-0. 028、-0. 024,P=0. 494、0. 842、0. 869)。结论儿童干眼大多数属于短BUT型干眼,其BUT缩短,睑板腺缺失明显,LLT变薄。NIBUT与NIBUTav较BUT更客观准确,LLT较睑板腺缺失评分更有价值。非侵入性眼表综合分析仪及Lipview眼表面干涉仪可以客观准确评估儿童干眼的特点。
Objective To evaluate dry eye in children by Keratograph 5 M and lipiview ocular surface interometry.Methods Totally 98 children( 186 eyes) were firstly diagnosed as dry eye in Tianjin Medical University Eye Hospital in Jan to Aug of 2017.After completed questionnaires designed to detect subjective symptoms and ocular surface disease index( OSDI),children were underwent examinations including slit lamp,tear film break-up time( BUT),the Schirmertest( SⅠT),Keratograph 5 M and lipiview ocular surface interometry.Results Eyes with BUT < 5 s were 159 and with SⅠT <5 mm per5 min were 30.OSDI [13.63( 9.09-15.91) ]was not correlated with SIt [( 14.6 ± 8.7) mm ]( r =-0.119,P = 0.259) and BUT [3.00( 2.00-5.00) s ]( r = 0.099,P = 0.354).First noninvasive tear film break-up time( NIBUT) and average noninvasive tear film break-up time( NIBUTav) were positively correlated with OSDI,NIBUT was strongly and positively correlated with NIBUTav( P <0.05).NIBUT and NIBUTav were not correlated with BUT( r = 0.112,0.059,P =0.159,0.455).Lipid layer thickness( LLT) and the max of LLT were positively correlated with NIBUTav,partial blink rate was negatively correlated with NIBUTav( P <0.05).Other indexes were not correlated with OSDI or NIBUTav.LLT,the max of LLT and min of LLT were not correlated with meibomian gland dropout degree( r =-0.083,-0.028,-0.024,P = 0.494,0.842,0.869).Conclusion In dry eye of children,short-BUT is the common type.BUT become shorter,meibomian gland dropout become bigger and LLT become thinner.NIBUT and NIBUTav are more accurate than BUT.LLT is more useful than Meiboscore.Keratograph 5 M and lipview ocular surface interometry can evaluate dry eye in children objectively and succinctly.
Objective To evaluate dry eye in children by Keratograph 5 M and lipiview ocular surface interometry.Methods Totally 98 children( 186 eyes) were firstly diagnosed as dry eye in Tianjin Medical University Eye Hospital in Jan to Aug of 2017.After completed questionnaires designed to detect subjective symptoms and ocular surface disease index( OSDI),children were underwent examinations including slit lamp,tear film break-up time( BUT),the Schirmertest( SⅠT),Keratograph 5 M and lipiview ocular surface interometry.Results Eyes with BUT < 5 s were 159 and with SⅠT <5 mm per5 min were 30.OSDI [13.63( 9.09-15.91) ]was not correlated with SIt [( 14.6 ± 8.7) mm ]( r =-0.119,P = 0.259) and BUT [3.00( 2.00-5.00) s ]( r = 0.099,P = 0.354).First noninvasive tear film break-up time( NIBUT) and average noninvasive tear film break-up time( NIBUTav) were positively correlated with OSDI,NIBUT was strongly and positively correlated with NIBUTav( P <0.05).NIBUT and NIBUTav were not correlated with BUT( r = 0.112,0.059,P =0.159,0.455).Lipid layer thickness( LLT) and the max of LLT were positively correlated with NIBUTav,partial blink rate was negatively correlated with NIBUTav( P <0.05).Other indexes were not correlated with OSDI or NIBUTav.LLT,the max of LLT and min of LLT were not correlated with meibomian gland dropout degree( r =-0.083,-0.028,-0.024,P = 0.494,0.842,0.869).Conclusion In dry eye of children,short-BUT is the common type.BUT become shorter,meibomian gland dropout become bigger and LLT become thinner.NIBUT and NIBUTav are more accurate than BUT.LLT is more useful than Meiboscore.Keratograph 5 M and lipview ocular surface interometry can evaluate dry eye in children objectively and succinctly.
引文
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[5]QI Y Y,ZHAO S Z,HUANG Y,YANG R B,WANG G Q.Clinical value evaluation of a new noninvasive ocular analyzer for the assessment of dry eye[J].Chin J Exp Ophthalmol,2015,33(2):165-169.祁媛媛,赵少贞,黄悦,杨瑞波,王桂琴.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.
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[7]SMITH J A.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye WorkShop(2007)[J].Ocul Surf,2007,5(2):93-107.
[8]TSUBOTA K,YOLOI N,SHIMAZAKI J,WATANABE H,DOGRUM,YAMADA M,et al.New perspectives on dry eye definition and diagnosis:a consensus report by the asia dry eye society[J].Ocul Surf,2017,15(1):65-76.
[9]CRAIG J P,NELSON J D,AZAR D T,BELMONTE C,BRON A J,CHAUHAN S K,et al.TFOS DEWS II report executive summary[J].Ocul Surf,2017,15(4):802-812.
[10]MAKATEB A,TORABIFARD H.Dry eye signs and symptoms in night-time workers[J].J Curr Ophthalmol,2017,29(4):270-273.
[11]VEHOF J,SILLEVIS SMITT-KAMMINGA N,NIBOURG S A,HAMMOND C J.Predictors of discordance between symptoms and signs in dry eye disease[J].Ophthalmology,2017,124(3):280-286.
[12]BARTLETT J D,KEITH M S,SUDHARSHAN L,SNEDECOR SJ.Associations between signs and symptoms of dry eye disease:a systematic review[J].Clin Ophthalmol,2015,16(9):1719-1730.
[13]CARDONA G,MARCELLAN C,FORNIELES A,VILASECA M,QUEVEDO L.Temporal stability in the perception of dry eye ocular discomfort symptoms[J].Optom Vis Sci,2010,87(12):1023-1029.
[14]JONE S,SOPHIE M,NISCHA L,KEN K.The non-invasive tear film break-up time in normal children[J].Br J Ophthalmol,2013,97(9):1129-1133.
[15]WU Y,LI H,TANG Y,YAN X.Morphological evaluation of meibomian glands in children and adolescents using noncontact infrared meibography[J].J Pediatr Ophthalmol Strabismus,2017,54(2):78-83.
[16]ZHU K X,XIE W J,YING J L,YAO Y F.Evaluation of tear film and meibomian gland function in dry eye patients using Keratograph 5M[J].J Zhengjiang Univ(Med Sci),2016,45(4):422-428.诸科璇,谢文加,应靖璐,姚玉峰.运用Keratograph 5M眼表综合分析仪评价干眼患者的泪膜及睑板腺功能[J].浙江大学学报(医学版),2016,45(4):422-428.
[17]MIZOGUCHI T,ARITA R,FUKUOKA S,MORISHIGE N.Morphology and function of meibomian glands and other tear film parameters in junior high school students[J].Cornea,2017,36(8):922.
[18]BRAUN R J,KING-SMITH P E,BEGLEY C G,LI L,GEWECKE NR.Dynamics and function of the tear film in relation to the blink cycle[J].Prog Retin Eye Res,2015,45(10):132-164.
[19]KAWASHIMA M,TSUBOTA K.Tear lipid layer deficiency associated with incomplete blinking:A case report[J].BMC Ophthalmol,2013,13(1):34.
[2]WANG X,WEI R H,ZHANG H M,YANG L Y,LIU Z Z,GU T P,et al.Evaluation of dry eye and meibomian gland and dysfuction in myopic teenagers by non invasive keratograph[J].Rec Adv Ophthalmol,2016,36(1):31-34.王秀,魏瑞华,张红梅,杨丽媛,刘珠珠,谷天瀑,等.非侵入式眼表综合分析仪评估近视青少年干眼和睑板腺功能障碍[J].眼科新进展,2016,36(1):31-34.
[3]BANAYOT R G.A retrospective analysis of eye conditions among children attending St.John Eye Hospital,Hebron,Palestine[J].BMC Res Notes,2016,9(1):202.
[4]CORNEA GROUP OF OPHTHALMOLOGY SOCIETY OF CHI-NESE MEDICAL ASSOCIATION.Expert consensus on dry eye diagnosis and treatment(2013)[J].Chin J Ophthalmol,2013,49(1):73-75.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.
[5]QI Y Y,ZHAO S Z,HUANG Y,YANG R B,WANG G Q.Clinical value evaluation of a new noninvasive ocular analyzer for the assessment of dry eye[J].Chin J Exp Ophthalmol,2015,33(2):165-169.祁媛媛,赵少贞,黄悦,杨瑞波,王桂琴.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.
[6]WU H,WANG Y,DONG N,YANG F,LIN Z,SHANG X,et al.Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers[J].PLoS One,2014,9(8):e105575-e105575.
[7]SMITH J A.The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye WorkShop(2007)[J].Ocul Surf,2007,5(2):93-107.
[8]TSUBOTA K,YOLOI N,SHIMAZAKI J,WATANABE H,DOGRUM,YAMADA M,et al.New perspectives on dry eye definition and diagnosis:a consensus report by the asia dry eye society[J].Ocul Surf,2017,15(1):65-76.
[9]CRAIG J P,NELSON J D,AZAR D T,BELMONTE C,BRON A J,CHAUHAN S K,et al.TFOS DEWS II report executive summary[J].Ocul Surf,2017,15(4):802-812.
[10]MAKATEB A,TORABIFARD H.Dry eye signs and symptoms in night-time workers[J].J Curr Ophthalmol,2017,29(4):270-273.
[11]VEHOF J,SILLEVIS SMITT-KAMMINGA N,NIBOURG S A,HAMMOND C J.Predictors of discordance between symptoms and signs in dry eye disease[J].Ophthalmology,2017,124(3):280-286.
[12]BARTLETT J D,KEITH M S,SUDHARSHAN L,SNEDECOR SJ.Associations between signs and symptoms of dry eye disease:a systematic review[J].Clin Ophthalmol,2015,16(9):1719-1730.
[13]CARDONA G,MARCELLAN C,FORNIELES A,VILASECA M,QUEVEDO L.Temporal stability in the perception of dry eye ocular discomfort symptoms[J].Optom Vis Sci,2010,87(12):1023-1029.
[14]JONE S,SOPHIE M,NISCHA L,KEN K.The non-invasive tear film break-up time in normal children[J].Br J Ophthalmol,2013,97(9):1129-1133.
[15]WU Y,LI H,TANG Y,YAN X.Morphological evaluation of meibomian glands in children and adolescents using noncontact infrared meibography[J].J Pediatr Ophthalmol Strabismus,2017,54(2):78-83.
[16]ZHU K X,XIE W J,YING J L,YAO Y F.Evaluation of tear film and meibomian gland function in dry eye patients using Keratograph 5M[J].J Zhengjiang Univ(Med Sci),2016,45(4):422-428.诸科璇,谢文加,应靖璐,姚玉峰.运用Keratograph 5M眼表综合分析仪评价干眼患者的泪膜及睑板腺功能[J].浙江大学学报(医学版),2016,45(4):422-428.
[17]MIZOGUCHI T,ARITA R,FUKUOKA S,MORISHIGE N.Morphology and function of meibomian glands and other tear film parameters in junior high school students[J].Cornea,2017,36(8):922.
[18]BRAUN R J,KING-SMITH P E,BEGLEY C G,LI L,GEWECKE NR.Dynamics and function of the tear film in relation to the blink cycle[J].Prog Retin Eye Res,2015,45(10):132-164.
[19]KAWASHIMA M,TSUBOTA K.Tear lipid layer deficiency associated with incomplete blinking:A case report[J].BMC Ophthalmol,2013,13(1):34.