Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK.
Department of Ophthalmology, 251 Hellenic Airforce General Hospital, Hpeirou 36, Agia Paraskeyi, 15341, Athens, Greece.
Int Ophthalmol. 2022 Oct;42(10):3017-3025. doi: 10.1007/s10792-022-02287-5. Epub 2022 Apr 8.
To evaluate preoperatively dry eye disease (DED) in patients with pathological Tear Break Up Time (TBUT), utilising subjective Ocular Surface Disease Index (OSDI) with its subcategories and objective Keratograph 5M characteristics.
Fifty-four cataract patients were included in this prospective study having a screening slit lamp TBUT of less than 10 s and more or equal to 5 s. Subjective evaluation of DED was performed with OSDI questionnaire and objective evaluation with Keratograph 5M. Tear Meniscus Height (TMH), bulbar and limbal redness and meibography grade were evaluated. Further analysis of OSDI subcategories, Visual Function Related (VFR), Ocular Symptoms related (OS) and Environmental Triggered (ET), was performed with linear and logistic multivariate regression models. Age, gender and logMAR visual acuity (VA) were also included in our models.
Following the initial TBUT screening we identified 27(50%) normal and 27(50%) dry eye patients, using OSDI questionnaire. There was no statistical difference in TMH (p = 0.64), bulbar redness (p = 0.54), limbal redness (p = 0.72) and meibography grade (p = 0.25), between normal and dry eye OSDI group. In our regression analysis, average logMAR VA was highly associated with a higher total OSDI score (p < 0.001) and with a higher OSDI-VFR score (p < 0.001). Female gender was associated with a higher OSDI-ET score (p = 0.03). Multivariate logistic regression models were performed by sorting patients into 2 categories of normal and dry eye group according to their total OSDI,OSDI-VRF,OSDI-OS and OSDI-ET score. An increase in logMAR VA increased the odds of having abnormal total OSDI score (p = 0.007) and OSDI-VFR score (p = 0.006). Females had increased odds of having abnormal OSDI-ET score (p = 0.044).
Clinicians should be aware of OSDI limitations when screening cataract patients for dry eyes, as there is high correlation with VA. Female patients were more susceptible to environmental factors. Keratograph results should be interpreted with caution when they are evaluated in conjunction with OSDI during preoperative assessment of DED in cataract patients.
利用主观眼表疾病指数（OSDI）及其亚类和客观角膜 5M 特征，评估病理性泪膜破裂时间（TBUT）＜10s 且≥5s 的白内障患者术前干眼情况。
本前瞻性研究纳入 54 例白内障患者，这些患者的筛查性裂隙灯 TBUT 小于 10s 但大于或等于 5s。使用 OSDI 问卷对干眼进行主观评估，使用角膜 5M 进行客观评估。评估泪膜半月板高度（TMH）、球结膜和角膜缘充血以及睑板腺照相分级。还使用线性和逻辑多元回归模型对 OSDI 亚类（视觉功能相关（VFR）、眼表症状相关（OS）和环境触发（ET））进行进一步分析。年龄、性别和 logMAR 视力（VA）也纳入我们的模型。
根据 OSDI 问卷，在初始 TBUT 筛查后，我们确定了 27 例（50%）正常眼和 27 例（50%）干眼患者。正常眼和干眼 OSDI 组之间 TMH（p=0.64）、球结膜充血（p=0.54）、角膜缘充血（p=0.72）和睑板腺照相分级（p=0.25）无统计学差异。在我们的回归分析中，平均 logMAR VA 与较高的总 OSDI 评分（p<0.001）和较高的 OSDI-VFR 评分（p<0.001）高度相关。女性与较高的 OSDI-ET 评分相关（p=0.03）。根据他们的总 OSDI、OSDI-VRF、OSDI-OS 和 OSDI-ET 评分，将患者分为正常眼和干眼组 2 类，进行多元逻辑回归模型分析。logMAR VA 的增加增加了异常总 OSDI 评分（p=0.007）和 OSDI-VFR 评分（p=0.006）的可能性。女性发生异常 OSDI-ET 评分的可能性增加（p=0.044）。
当筛查白内障患者的干眼时，临床医生应注意 OSDI 的局限性，因为它与 VA 有高度相关性。女性患者更容易受到环境因素的影响。在评估白内障患者术前干眼的角膜 5M 结果时，应谨慎解释与 OSDI 相结合的结果。
