The University of Sydney. Sydney, Australia, Postal address: 6 Byron Street, Coogee, NSW, 2034, Australia.
Concord Repatriation General Hospital, Sydney, NSW, Australia.
Eye (Lond). 2018 Aug;32(8):1387-1391. doi: 10.1038/s41433-018-0101-8. Epub 2018 May 10.
The aims of this study are as follows: (1) to describe a standardised methodology for the ice test, and where necessary a heat test; (2) to determine the effects of local cooling vs. heating on ptosis in myasthenia gravis (MG) patients.
Twenty-three MG patients with ptosis were identified from a tertiary referral neuroimmunology clinic, seventeen with significant ptosis ≥2 mm. Latex party balloons were filled with ice and cold tap water for the ice test, or with water heated to 45 °C for the heat test. Each test was performed for 2 min, with ruler measurement and photographs taken of the palpebral aperture before and immediately after each test.
This standardised method was efficient in a clinical setting while maintaining efficacy. In all 23 patients, the mean improvements in ptosis with the ice, rest, and heat tests were 2.3 (±1.5) mm, 1.3 (±1.1) mm, and 0.33 (±1.4) mm respectively. In the 17 patients with significant ptosis, the mean improvements in ptosis with the ice, rest, and heat tests were 2.9 (±1.2) mm, 1.8 (±0.92) mm, and 0.83 (±1.4) mm, respectively. In these 17 patients, the ice test improved ptosis by 1.3 mm more than rest (p < 0.0001). The heat test improved ptosis by 1.1 mm less than rest (p = 0.0013). The ice test improved ptosis by 2.3 mm more than the heat test (p < 0.0001).
The standardised methodology of ice and heat testing was safe, easily reproducible and effective. We confirm that temperature had a significant effect on ptosis in MG, and therefore refute the notion that measured changes are purely due to the associated rest.
本研究的目的如下：（1）描述冰试验（如果有必要，还包括热试验）的标准化方法；（2）确定局部冷却与加热对重症肌无力（MG）患者上睑下垂的影响。
从三级转诊神经免疫诊所确定了 23 例 MG 伴上睑下垂的患者，其中 17 例患者上睑下垂明显（≥2mm）。乳胶派对气球用于冰试验，填充冰和冷水；用于热试验，填充加热至 45°C 的水。每个测试持续 2 分钟，在每次测试前后使用尺子测量和拍摄睑裂照片。
这种标准化方法在临床环境中效率高，同时保持疗效。在所有 23 例患者中，冰、休息和热试验对上睑下垂的平均改善分别为 2.3（±1.5）mm、1.3（±1.1）mm 和 0.33（±1.4）mm。在 17 例上睑下垂明显的患者中，冰、休息和热试验对上睑下垂的平均改善分别为 2.9（±1.2）mm、1.8（±0.92）mm 和 0.83（±1.4）mm。在这 17 例患者中，冰试验对上睑下垂的改善比休息多 1.3mm（p<0.0001）。热试验对上睑下垂的改善比休息少 1.1mm（p=0.0013）。冰试验对上睑下垂的改善比热试验多 2.3mm（p<0.0001）。
冰和热试验的标准化方法安全、易于复制且有效。我们证实温度对上睑下垂有显著影响，因此反驳了所测量的变化纯粹是由于相关休息引起的观点。
