Castro-Lima-Vargens Cristina, Grassi Maria Fernanda Rios, Boa-Sorte Ney, Rathsam-Pinheiro Regina Helena, Almeida Paula Caroline Matos, Galvão-Castro Bernardo
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira, Salvador, BA, Brazil.
Arq Bras Oftalmol. 2017 Nov-Dec;80(6):369-372. doi: 10.5935/0004-2749.20170090.
To evaluate the accuracy of lacrimal film tests and propose an algorithm for the diagnosis of dry eye disease in individuals infected with human T-cell lymphotropic virus type 1.
Ninety-six patients infected with human T-cell lymphotropic virus type 1 were enrolled in the study. To assess clinical complaints, patients completed the Ocular Surface Disease Index questionnaire. To evaluate lacrimal film quality, patients underwent the tear breakup time test, Schirmer I test, and Rose Bengal staining. Dry eye disease was diagnosed when at least two of the three test results were abnormal. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of the questionnaire as well as of each test alone and combined in parallel and in series were determined.
The most sensitive test was the tear breakup time test (98%), whereas the most specific was the Schirmer I test (100%). Rose Bengal staining had the highest overall accuracy (88.64%), whereas the Ocular Surface Disease Index had the lowest overall accuracy (62.65%). The tear breakup time test, Schirmer I test, and Ocular Surface Disease Index combined in parallel showed increased sensitivity and decreased specificity for all tests. In contrast, when combined in series, these tests demonstrated increased specificity and decreased sensitivity.
This study shows the need to use multiple tests to evaluate tear film quality and include a symptom questionnaire as part of the diagnostic algorithm for dry eye disease.
评估泪膜测试的准确性，并提出一种针对感染1型人类嗜T细胞病毒个体的干眼病诊断算法。
96名感染1型人类嗜T细胞病毒的患者纳入本研究。为评估临床症状，患者完成眼表疾病指数问卷。为评估泪膜质量，患者接受泪膜破裂时间测试、Schirmer I试验和孟加拉玫瑰红染色。当三项测试结果中至少两项异常时，诊断为干眼病。确定问卷以及每项测试单独使用、平行联合和串联联合时的敏感性、特异性、阳性和阴性预测值以及总体准确性。
最敏感的测试是泪膜破裂时间测试（98%），而最特异的是Schirmer I试验（100%）。孟加拉玫瑰红染色总体准确性最高（88.64%），而眼表疾病指数总体准确性最低（62.65%）。泪膜破裂时间测试、Schirmer I试验和眼表疾病指数平行联合时，所有测试的敏感性增加而特异性降低。相反，串联联合时，这些测试显示特异性增加而敏感性降低。
本研究表明需要使用多种测试来评估泪膜质量，并将症状问卷纳入干眼病诊断算法。
