Remongin P-E, Rousseau A, Best A-L, Ben Hadj Salah W, Legrand M, Benichou J, Barreau E, Labetoulle M
Service d'Ophtalmologie, CHU Bicetre, AP-HP, université Paris-Saclay, 94275 Le Kremlin-Bicêtre, France.
Service d'Ophtalmologie, CHU Bicetre, AP-HP, université Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases. IDMIT Infrastructure. CEA,Université Paris Saclay, Inserm U1184, 18, route du Panorama, 92265 Fontenay-aux-Roses cedex, France.
J Fr Ophtalmol. 2021 Mar;44(3):313-320. doi: 10.1016/j.jfo.2020.06.045. Epub 2021 Feb 11.
Dry eye disease is a very frequent condition with a significant impact on patients' quality of life. The most common clinical sign is fluorescein break up time (BUT). Recently, non-invasive measurement of BUT (NIBUT) by Placido disc analysis has been proposed to replace FBUT. We performed an automated NIBUT analysis using Lacrydiag and compared the values obtained with other typical dry eye criteria.
A retrospective study was carried out in the Bicêtre ophthalmology department from July 1 through October 30. Dry eye patients over 18 years of age with Oxford scores>1 and OSDI scores>22 were included. They underwent slit lamp examination to determine fluorescein BUT, Oxford and Arita MGD scores. On the same day, they were tested with the Lacrydiag to assess NIBUT, tear lake height and meibography. OSDI and Schirmer's testing were performed on the date of examination. In this study, only patients' right eyes were included. The correlation between NIBUT and OSDI, Schirmer's testing and tear lake height was analyzed by Pearson's test. The correlation between NIBUT and fluorescein BUT was analysed by both Pearson and Bland-Altman statistical tests.
Thirty right eyes (21 women, 9 men) were included. The mean age was 62.3 years (SD 16.0), mean OSDI 49.4 (SD=20.1), mean Oxford score 3.33 (SD 2.1), mean NIBUT 6.91sec (SD 3.4), and mean FBUT 3.6sec (SD 1.8). The NIBUT and FBUT were significantly correlated (R=0.139; P=0.042), with an even more significant concordance (r=0.55; P=0.001) on Bland-Altman graphic analysis, but the mean NIBUT was 2.7 seconds higher than the FBUT (P=0.001 on Bland-Altman analysis). In addition, NIBUT was correlated with the Oxford score (R=0.156; P=0.031), but not with Schirmer I score (R=0.120; P=0.061), OSDI score (R=0.018; P=0.48), tear lake height (R=0.04; P=0.148), or Arita meibomian gland dysfunction score (R=0; P=0.933).
NIBUT is a possible alternative to FBUT for the measurement of tear film stability, with the advantage of lack of dependence on the amount of fluorescein instilled. In addition, modern imaging methods allow for automated, and thus reproducible, measurement. However, its role in the diagnostic tool kit remains to be precisely defined, especially given its weak correlation with other markers of dry eye and its significant difference from FBUT. The definitive diagnosis of dry eye thus remains based on the combined analysis of signs and symptoms.
干眼症是一种非常常见的病症，对患者的生活质量有重大影响。最常见的临床体征是荧光素泪膜破裂时间（BUT）。最近，有人提出通过Placido盘分析进行非侵入性BUT测量（NIBUT）以取代FBUT。我们使用Lacrydiag进行了自动NIBUT分析，并将获得的值与其他典型的干眼标准进行了比较。
于7月1日至10月30日在比塞特尔眼科进行了一项回顾性研究。纳入年龄超过18岁、牛津评分>1且眼表疾病指数（OSDI）评分>22的干眼症患者。他们接受了裂隙灯检查以确定荧光素BUT、牛津和有田睑板腺功能障碍（MGD）评分。在同一天，使用Lacrydiag对他们进行测试以评估NIBUT、泪湖高度和睑板腺造影。在检查当天进行OSDI和Schirmer试验。在本研究中，仅纳入患者的右眼。通过Pearson检验分析NIBUT与OSDI、Schirmer试验和泪湖高度之间的相关性。通过Pearson和Bland-Altman统计检验分析NIBUT与荧光素BUT之间的相关性。
纳入了30只右眼（21名女性，9名男性）。平均年龄为62.3岁（标准差16.0），平均OSDI为49.4（标准差=20.1），平均牛津评分为3.33（标准差2.1），平均NIBUT为6.91秒（标准差3.4），平均FBUT为3.6秒（标准差1.8）。NIBUT与FBUT显著相关（R=0.139；P=0.042），在Bland-Altman图形分析中一致性更强（r=0.55；P=␣0.001），但平均NIBUT比FBUT高2.7秒（Bland-Altman分析中P=0.001）。此外，NIBUT与牛津评分相关（R=0.156；P=0.031），但与Schirmer I评分（R=0.120；P=0.061）、OSDI评分（R=0.018；P=0.48）、泪湖高度（R=0.04；P=0.148）或有田睑板腺功能障碍评分（R=0；P=0.933）无关。
NIBUT是测量泪膜稳定性时FBUT的一种可能替代方法，其优点是不依赖于所滴入荧光素的量。此外，现代成像方法允许进行自动测量，从而具有可重复性。然而，其在诊断工具包中的作用仍有待精确界定，特别是考虑到它与其他干眼标志物的相关性较弱以及与FBUT存在显著差异。因此，干眼症的明确诊断仍然基于体征和症状的综合分析。
