Klaassen-Broekema N, van Bijsterveld O P
Oogcentrum Houten, Achterom 16B, The Netherlands.
Graefes Arch Clin Exp Ophthalmol. 1995 Nov;233(11):717-20. doi: 10.1007/BF00164676.
It is generally accepted that the elevated calcium phosphate product in dialysis patients is associated with the development of extraskeletal calcification. There is, however, no clear association between the raised levels of calcium and phosphate ions and the degree of limboconjunctival calcification. This article focuses on the role of tissue devitalisation in the development of ocular calcification.
Local injury of the outer eye can be visualised by the Lissamine green staining test. We measured the pre- and postdialysis staining score in 38 dialysis patients. The differences between pre- and postdialysis tear fluid secretion and tearfilm stability were also assessed, as was the degree of limboconjunctival calcification. Serum calcium and phosphate levels were measured in all patients.
In 14 of the 38 patients, demonstrable tissue injury was present as a result of a recurrent decrease of tear secretion after each dialysis session. There was a statistically significant association between the degree of limboconjunctival calcification and both the difference between the pre- and postdialysis Lissamine green staining score and the total number of haemodialysis sessions.
Local factors, such as minor tissue injury of the limboconjunctival epithelium, referred to as "local challenger", are more likely to determine the degree of ocular calcification in dialysis patients than are systemic factors. Tissue injury of the outer eye in these patients is the result of a chronic decrease of tear fluid that occurs after each hemodialysis session.
一般认为，透析患者中钙磷乘积升高与骨骼外钙化的发生有关。然而，钙离子和磷酸根离子水平升高与睑结膜钙化程度之间并无明确关联。本文重点关注组织失活在眼部钙化发生过程中的作用。
外眼局部损伤可通过丽丝胺绿染色试验观察到。我们对38例透析患者透析前后的染色评分进行了测量。还评估了透析前后泪液分泌和泪膜稳定性的差异，以及睑结膜钙化程度。对所有患者测定血清钙和磷水平。
38例患者中有14例在每次透析后出现泪液分泌反复减少，表现出明显的组织损伤。睑结膜钙化程度与透析前后丽丝胺绿染色评分的差异及血液透析总次数之间存在统计学显著关联。
局部因素，如睑结膜上皮的轻微组织损伤，即“局部挑战者”，比全身因素更有可能决定透析患者眼部钙化的程度。这些患者外眼的组织损伤是每次血液透析后泪液慢性减少的结果。
