Lievens Christopher W, Norgett Yvonne, Briggs Nancy, Allen Peter M, Vianya-Estopa Marta
The Eye Center, Southern College of Optometry, Memphis, TN, USA.
Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK.
Clin Ophthalmol. 2020 Oct 6;14:3039-3047. doi: 10.2147/OPTH.S273524. eCollection 2020.
Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked.
A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl).
There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p<0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl.
The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.
眼科染料在诊断睑板擦痕上皮病变（LWE）时使用方法的差异导致了文献和临床实践中的分歧。本研究的主要目的是评估使用非最佳方法识别LWE是否存在假阴性的可能性，即LWE被漏诊。
共有20名最初被归类为无LWE的参与者纳入本研究。该方案检查了通过使用优化方法LWE是否会在之后被发现。对使用丽丝胺绿（LG）和荧光素钠（NaFl）进行两次不同滴眼后在不同染料后观察时间拍摄的图像进行了半自动分析。
当使用识别LWE的最佳方法时，染色面积显著增加。每种非最佳条件与最佳条件相比在统计学上有显著差异（所有p<0.01）。使用非最佳方法时，使用LG时假阴性率为70%，使用NaFl时假阴性率为95%。
该研究表明，即使延长临床观察等待时间，双滴染料法与单剂量法在统计学上仍有差异。单次滴注不能提供足够量的染料以充分摄取睑缘。严格控制染料量以及重复给药是发现LWE全部病变区域的关键。诊断LWE的非最佳方法可导致假阴性。
