使用 TearLab 渗透压系统测量泪液渗透压评估干眼治疗效果。

Tear osmolarity measurement using the TearLab Osmolarity System in the assessment of dry eye treatment effectiveness.

机构信息

Department of Neurosciences Section of Ophthalmology, University of Pisa, Italy.

出版信息

Cont Lens Anterior Eye. 2010 Apr;33(2):61-7. doi: 10.1016/j.clae.2010.01.003. Epub 2010 Feb 12.

DOI:10.1016/j.clae.2010.01.003

PMID:20153684

Abstract

PURPOSE

To evaluate the efficacy of three commercially available lubricant eye drops for the treatment of mild, dry, irritated eyes.

METHODS

Randomized, investigator-masked evaluation of 60 patients in which 20 patients used carboxymethylcellulose sodium (CMC), 0.5% (Cellufresh), Allergan Inc., Irvine, CA) (group 1); 20 patients used a drop containing polyethylene glycol 400, 2.5% and sodium hyaluronate (Blink Intensive Tears, Abbott Medical Optics Inc., Santa Ana, CA) (group 2); and 20 patients used HP Guar 0.18% (Systane, Alcon Laboratories Inc., Ft. Worth, TX) (group 3). Study visits were at baseline and 1 month. Tests performed at both visits included Schirmer, tear-film break-up time (TBUT), visual acuity, fluorescein staining, tear osmolarity and wavefront aberrometry. Osmolarity testing was performed prior to instillation of the lubricant eye drops and then a final time 5min after instillation of the drop at both day 1 and day 30. Tear osmolarity was performed only in the right eye and only one time before and after instillation of lubricant eye drops.

RESULTS

At day 1 the mean reduction in osmolarity 5min after instillation of the lubricant eye drop was, -5.0+/-1.9 in group 1, -9.0+/-4.2 in group 2 and -5.0+/-2.2 in group 3. At day 30 the mean reduction in osmolarity 5min after instillation of the lubricant eye drop was, -5.6+/-2.3mOsm/L in group 1; -9.9+/-2.8mOsm/L in group 2 and -4.5+/-1.8mOsm/L in group 3. The differences were statistically significant between groups 1 and 2, and 2 and 3. There was a reduction of osmolarity from day 1 to day 30 but the differences were not statistically significant. We feel that after a 30-day treatment with the lubricant eye drops, the lower osmolarity values could indicate that the tear film is progressing towards a more normal osmolarity value. A future study could examine the tear osmolarity value after 60 or 90 days of usage. LogMAR best-corrected visual acuity (BCVA) results showed an improvement in group 2 compared with baseline with no change in BCVA in groups 1 and 3. There was no statistically significant change from day 1 to 1 month in TBUT, while the Schirmer test showed an improvement in all groups at 1 month.

CONCLUSIONS

Assessment of tear osmolarity provides the most objective, measurable test for determining improvement in dry eye patients. The instillation of any artificial tear or lubricant eye drop should decrease the tear-film osmolarity. The results found that polyethylene glycol 400, 0.25% and sodium hyaluronate (Blink Intensive Tears) significantly improved tear osmolarity compared with carboxymethylcellulose sodium (CMC), 0.5% (Cellufresh) and HP Guar 0.18% (Systane after instillation.

摘要

目的

评估三种市售润滑滴眼液治疗轻度、干燥、刺激眼睛的疗效。

方法

对 60 例患者进行随机、研究者盲法评估，其中 20 例患者使用羧甲基纤维素钠（CMC），0.5%（Cellufresh），Allergan Inc.，Irvine，CA）（第 1 组）；20 例患者使用含有聚乙烯二醇 400、2.5%和透明质酸钠的滴剂（Blink Intensive Tears，雅培医疗光学公司，圣安娜，CA）（第 2 组）；20 例患者使用 HP Guar 0.18%（Systane，爱尔康实验室公司，沃思堡，TX）（第 3 组）。研究访视在基线和 1 个月时进行。两次访视均进行 Schirmer、泪膜破裂时间（TBUT）、视力、荧光素染色、泪液渗透压和波前像差检查。渗透压测试在滴注润滑眼液之前进行，然后在第 1 天和第 30 天滴注后 5 分钟时进行最后一次测试。仅在右眼进行泪液渗透压测试，并且仅在滴注润滑眼液之前和之后进行一次测试。

结果

第 1 天滴注润滑眼液后 5 分钟时渗透压的平均降低值为第 1 组-5.0+/-1.9，第 2 组-9.0+/-4.2，第 3 组-5.0+/-2.2。第 30 天滴注润滑眼液后 5 分钟时渗透压的平均降低值为第 1 组-5.6+/-2.3mOsm/L；第 2 组-9.9+/-2.8mOsm/L；第 3 组-4.5+/-1.8mOsm/L。组 1 和组 2 之间以及组 2 和组 3 之间的差异具有统计学意义。从第 1 天到第 30 天，渗透压降低，但差异无统计学意义。我们认为，经过 30 天的润滑眼液治疗，较低的渗透压值可能表明泪膜正在向更正常的渗透压值发展。未来的研究可以检查使用润滑眼液 60 或 90 天后的泪液渗透压值。对数最小分辨角对数最佳矫正视力（BCVA）结果显示，第 2 组与基线相比有所改善，而第 1 组和第 3 组的 BCVA 没有变化。TBUT 从第 1 天到 1 个月没有统计学意义上的变化，而 Schirmer 测试显示所有组在 1 个月时都有所改善。

结论

评估泪液渗透压为评估干眼患者的改善情况提供了最客观、可衡量的测试。任何人工泪液或润滑眼液的滴注都应降低泪膜渗透压。结果发现，与羧甲基纤维素钠（CMC），0.5%（Cellufresh）和 HP Guar 0.18%（Systane）相比，聚乙烯二醇 400、0.25%和透明质酸钠（Blink Intensive Tears）在滴注后明显改善了泪液渗透压。