Masmali Ali M, Maeni Yahya A, El-Hiti Gamal A, Murphy Paul J, Almubrad Turki
Department of Optometry (A.M.M., Y.A.M., G.A.E., T.A.), College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; School of Optometry and Vision Science (P.J.M.), University of Waterloo, Waterloo, ON, Canada; and School of Optometry and Vision Sciences (P.J.M.), Cardiff University, Cardiff, United Kingdom.
Eye Contact Lens. 2018 Nov;44 Suppl 2:S70-S75. doi: 10.1097/ICL.0000000000000419.
To investigate the ocular tear film in controlled and uncontrolled diabetes mellitus (DM) subjects and the relationship between dry eye and diabetes.
One hundred twenty-four diabetes adults (65 male and 59 female, with 62 controlled and 62 uncontrolled DM) were assessed by McMonnies dry eye questionnaire, tear break-up time (TBUT), phenol red thread (PRT) test. In addition, tear samples were collected from the lower tear meniscus of right eyes and dried onto glass slides under controlled room temperature (25°C) and humidity (40%). The glass slides were observed using a digital microscopy and the tear ferning (TF) patterns observed were graded based on Masmali TF grading scale. Patients with a HbA1c value below 6.5% were defined as "controlled DM" and those with a HbA1c value above 6.5% were defined as "uncontrolled DM." The Spearman's correlation coefficient was used to determine the relationship between various tests.
Several subjects having dry eye varied depending on the test used. McMonnies questionnaire scores suggested that 28 subjects (23%) showed dry eye (score >14.5), of whom 23 subjects (82%) showed uncontrolled diabetes. The TF patterns showed that 44 subjects (35.5%) showed dry eyes (Grade ≥2), of whom 32 subjects (72.7%) showed uncontrolled diabetes. Phenol red thread test found that 46 subjects (37%) showed dry eye (wetting <10 mm), of whom 38 subjects (82.6%) showed uncontrolled diabetes. Tear break-up time found that 57 subjects (46%) showed dry eye (time <10 sec), of whom 45 subjects (78.9%) showed uncontrolled diabetes. In controlled diabetic subjects, TF grades showed medium negative correlations with both TBUT and PRT (-0.374 and -0.349, respectively). In uncontrolled subjects, TF grades have a strong negative correlation with TBUT (-0.539) and a medium negative correlation with PRT (-0.410).
Dry eye disease is common in diabetic subjects, particularly in people with poor diabetic control. Uncontrolled blood glucose level seemed to be a risk factor for dry eye syndrome. Tear ferning test showed a correlation between diabetes and dry eye in diabetic subjects and can be used as a reliable test to evaluate the quality of the ocular tear film.
研究血糖控制良好和控制不佳的糖尿病（DM）患者的眼表泪膜，以及干眼与糖尿病之间的关系。
采用McMonnies干眼问卷、泪膜破裂时间（TBUT）、酚红棉线（PRT）试验对124例成年糖尿病患者（男性65例，女性59例，其中血糖控制良好者62例，控制不佳者62例）进行评估。此外，从右眼下方泪湖采集泪液样本，在室温（25°C）和湿度（40%）控制的条件下干燥于载玻片上。使用数码显微镜观察载玻片，并根据Masmali泪液蕨样变（TF）分级量表对观察到的泪液蕨样变模式进行分级。糖化血红蛋白（HbA1c）值低于6.5%的患者被定义为“血糖控制良好的DM”，HbA1c值高于6.5%的患者被定义为“血糖控制不佳的DM”。采用Spearman相关系数确定各项检查之间的关系。
根据所使用的检查方法，干眼患者的数量有所不同。McMonnies问卷评分显示，28例患者（23%）存在干眼（评分>14.5），其中23例患者（82%）患有血糖控制不佳的糖尿病。TF模式显示，44例患者（35.5%）存在干眼（分级≥2），其中32例患者（72.7%）患有血糖控制不佳的糖尿病。酚红棉线试验发现，46例患者（37%）存在干眼（湿润长度<10 mm），其中38例患者（82.6%）患有血糖控制不佳的糖尿病。泪膜破裂时间发现，57例患者（46%）存在干眼（时间<10秒），其中45例患者（78.9%）患有血糖控制不佳的糖尿病。在血糖控制良好的糖尿病患者中，TF分级与TBUT和PRT均呈中度负相关（分别为-0.374和-0.349）。在血糖控制不佳的患者中，TF分级与TBUT呈强负相关（-0.539），与PRT呈中度负相关（-0.410）。
干眼疾病在糖尿病患者中很常见，尤其是血糖控制不佳的患者。血糖控制不佳似乎是干眼综合征的一个危险因素。泪液蕨样变试验显示糖尿病患者的糖尿病与干眼之间存在相关性，可作为评估眼表泪膜质量的可靠检查方法。
