用于评估伴有睑板腺功能障碍的非干燥综合征干眼综合征的泪膜动力学和脂质层厚度的自动测量

Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction.

作者信息

Ji Yong Woo, Lee Jeihoon, Lee Hun, Seo Kyoung Yul, Kim Eung Kweon, Kim Tae-Im

机构信息

*Corneal Dystrophy Research Institute, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; †Institue of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; ‡Siloam Eye Hospital, Seoul, Korea; and §Department of Ophthalmology, International St Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.

出版信息

Cornea. 2017 Feb;36(2):176-182. doi: 10.1097/ICO.0000000000001101.

DOI:10.1097/ICO.0000000000001101

PMID:28060064

Abstract

PURPOSE

To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD).

METHODS

Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured.

RESULTS

Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms.

CONCLUSIONS

Automated noninvasive measurements using an advanced corneal topographer and LLT measured with an ocular surface interferometer can be alternatives to conventional methods to evaluate tear conditions on the ocular surface; the former device can provide information about conformational MG changes in NSDES with MGD.

摘要

目的

使用一款内置真实角膜曲率计、彩色相机和眼表干涉仪的先进角膜地形图仪，研究其自动测量值，以评估伴有睑板腺功能障碍（MGD）的非干燥综合征干眼（NSDES）。

方法

纳入64例（64只眼）诊断为伴有MGD的NSDES患者。所有眼睛均使用眼表疾病指数（OSDI）、荧光素染色评分、泪膜破裂时间（TBUT）、泪液分泌试验和MGD分级进行评估。测量非侵入性角膜地形图仪平均泪膜破裂时间（NIKBUTav）、泪河高度（TMHk）、睑板腺（MG）缺失分级以及使用干涉仪测量的脂质层厚度（LLT）。

结果

在自动测量指标中，NIKBUTav（平均7.68±4.07秒）和MG缺失分级（平均1.0±0.5）与OSDI（平均40.6±22.9）显著相关（r=-0.337，P=0.006；r=0.201，P=0.023），所有传统指标（除泪液分泌试验评分（平均9.1±5.9毫米）外）也是如此。TMHk（平均0.21±0.18毫米）与泪液分泌试验评分、染色评分（平均1.2±0.7）、TBUT（平均3.8±1.8秒）和NIKBUTav显著相关（r=0.298，P=0.007；r=-0.268，P=0.016；r=0.459，P<0.001；r=0.439，P<0.001），但与任何MGD指标均无相关性，甚至与MG缺失分级也无相关性。NIKBUTav与所有临床参数和其他自动测量值显著相关，但与泪液分泌试验评分和LLT（平均83.94±20.82纳米）除外（所有（公式包含在全文中）≥0.25且P<0.01）。MG缺失分级与除TMHk外的所有指标高度相关（所有（公式包含在全文中）≥0.25且P<0.05）。LLT与TBUT、MGD分级（平均2.0±0.7）和MG缺失分级显著相关（r=0.219，P=0.047；r=-0.221，P=0.039；r=0.433，P<0.001），尽管它与患者症状无关。