Indiana University School of Optometry, Bloomington, IN, USA.
Toronto Eye Care, Toronto, ON, Canada.
Ocul Surf. 2022 Jul;25:65-70. doi: 10.1016/j.jtos.2022.05.003. Epub 2022 May 11.
To explore the effect of time on grading corneal fluorescein and conjunctival lissamine green staining in dry eye disease (DED).
Photographs of 68 subjects with non-Sjogren's DED (nSS DED) and 32 with Sjogren's DED (SS DED) were taken of corneal fluorescein staining, then conjunctival lissamine green staining every 30 s for at least 5 min. Photographs of one randomly selected eye were then randomly ordered and graded on a scale from 0 to 5 (severe staining) by two clinicians, masked to both site and subject. The average time required to reach the maximum grade of staining (Gmax) was calculated.
The median time (upper and lower quartiles) to corneal fluorescein Gmax was 2.6 (1.3-5.3) minutes for nSS DED and 3.8 (2.6-5.4) minutes for SS DED, a statistically significant difference (Mann Whitney U test, p = 0.018). In contrast, the median time to the Gmax for lissamine green staining of the nasal and temporal conjunctiva was 0.5 (0.5-1.1 nasal, 0.5-0.8 temporal) minutes for nSS DED and 0.5 (0.5-0.8 nasal, 0.5-0.5 temporal) minutes for SS DED subjects, which was not statistically significant (p ≥ 0.383).
The time required to reach the maximum grade of corneal fluorescein staining, but not conjunctival lissamine green staining, varied widely and was significantly longer in subjects with Sjögren's Syndrome. Early observation of corneal fluorescein staining can lead to under-grading, which may impact the diagnosis and assessment of treatment in DED. Further study of the best time to assess corneal fluorescein staining in various DED populations is warranted.
探讨时间对干燥性眼病（DED）患者角膜荧光素和结膜丽丝胺绿染色分级的影响。
对 68 例非干燥综合征相关性 DED（nSS DED）患者和 32 例干燥综合征相关性 DED（SS DED）患者的角膜荧光素染色进行拍照，然后每 30 秒对结膜丽丝胺绿染色进行拍照，至少持续 5 分钟。然后随机选择一只眼睛的照片，由两名临床医生对其进行评分，评分范围为 0 至 5 级（重度染色），评分时临床医生对患者和地点均设盲。计算达到最大染色等级（Gmax）所需的平均时间。
nSS DED 患者角膜荧光素 Gmax 的中位数（上下四分位数）为 2.6（1.3-5.3）分钟，SS DED 患者为 3.8（2.6-5.4）分钟，差异具有统计学意义（Mann Whitney U 检验，p=0.018）。相比之下，nSS DED 患者鼻侧和颞侧结膜丽丝胺绿染色达到 Gmax 的中位数时间分别为 0.5（0.5-1.1 鼻侧，0.5-0.8 颞侧）分钟和 0.5（0.5-0.8 鼻侧，0.5-0.5 颞侧）分钟，SS DED 患者的中位数时间分别为 0.5（0.5-0.8 鼻侧，0.5-0.5 颞侧）分钟和 0.5（0.5-0.8 鼻侧，0.5-0.5 颞侧）分钟，差异无统计学意义（p≥0.383）。
达到角膜荧光素染色最大等级所需的时间差异很大，且 SS DED 患者明显更长，但结膜丽丝胺绿染色无此差异。早期观察角膜荧光素染色可能会导致低估，这可能会影响 DED 的诊断和治疗评估。有必要进一步研究各种 DED 人群中评估角膜荧光素染色的最佳时间。
