Miserocchi Elisabetta, Iuliano Lorenzo, Berchicci Luigi, Bandello Francesco, Modorati Giulio
Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Cornea. 2014 Jul;33(7):668-72. doi: 10.1097/ICO.0000000000000148.
The aim of this study was to evaluate tear film osmolarity in patients with ocular mucous membrane pemphigoid (MMP).
This observational cross-sectional study included 40 patients with biopsy-proven ocular MMP at Foster stage III referred to the tertiary-care Ocular Immunology and Uveitis Service at the San Raffaele Scientific Institute in Milan from June 2010 to August 2013. We evaluated the following clinical parameters: tear film osmolarity, ocular surface disease symptoms (OSDI) questionnaire, Schirmer test, tear film break-up time (TFBUT), and corneal and conjunctival staining.
Forty patients (27 women and 13 men) were enrolled. All patients were undergoing systemic immunosuppressive therapy: 19 patients (47.5%) were on methotrexate, 9 (22.5%) were on mycophenolate mofetil, 9 (22.5%) were on low-dose corticosteroids, and 3 (7.5%) were on azathioprine. The mean osmolarity was 322.90 ± 33.39 mOsm/L, the mean OSDI score was 73.2 ± 17.9, the mean TFBUT was 6.60 ± 3.13 seconds, and the mean Schirmer test value was 4.07 ± 3.58 seconds. Tear film osmolarity significantly correlated with the TFBUT (r = 0.80; P < 0.0001), whereas no clinical correlation was found with the Schirmer test value (r = 0.01; P = 0.40) or with the OSDI score (r = 0.02; P = 0.29). Osmolarity did not turn out to be statistically different in the subgroups according to the Oxford corneal staining scale (P = 0.71) and to the Van Bijsterveld conjunctival staining score (P = 0.31).
Tear osmolarity increased in patients with ocular MMP and correlated with the TFBUT. This result emphasizes the role of evaporative dry-eye condition in patients with ocular MMP. Tear osmolarity may be considered as a useful test in the diagnostic assessment of dry eye associated with MMP and for targeting therapeutic decisions.
本研究旨在评估眼黏膜类天疱疮（MMP）患者的泪膜渗透压。
这项观察性横断面研究纳入了2010年6月至2013年8月期间转诊至米兰圣拉斐尔科学研究所三级眼科免疫与葡萄膜炎科的40例经活检证实为福斯特III期眼MMP患者。我们评估了以下临床参数：泪膜渗透压、眼表疾病症状（OSDI）问卷、泪液分泌试验、泪膜破裂时间（TFBUT）以及角膜和结膜染色。
共纳入40例患者（27例女性和13例男性）。所有患者均接受全身免疫抑制治疗：19例患者（47.5%）使用甲氨蝶呤，9例（22.5%）使用霉酚酸酯，9例（22.5%）使用低剂量皮质类固醇，3例（7.5%）使用硫唑嘌呤。平均渗透压为322.90±33.39mOsm/L，平均OSDI评分为73.2±17.9，平均TFBUT为6.60±3.13秒，平均泪液分泌试验值为4.07±3.58秒。泪膜渗透压与TFBUT显著相关（r = 0.80；P < 0.0001），而与泪液分泌试验值（r = 0.01；P = 0.40）或OSDI评分（r = 0.02；P = 0.29）无临床相关性。根据牛津角膜染色量表（P = 0.71）和范·比斯特维尔德结膜染色评分（P = 0.31），各亚组的渗透压在统计学上无差异。
眼MMP患者的泪液渗透压升高且与TFBUT相关。这一结果强调了蒸发型干眼状态在眼MMP患者中的作用。泪液渗透压可被视为评估与MMP相关干眼的诊断及指导治疗决策的有用检测指标。
