非侵入式眼表综合分析仪评估近视青少年干眼和睑板腺功能障碍

目的 通过问卷调查和临床检查分析青少年近视患者干眼和眼表状况.方法 选取248例(496眼)7～18岁近视青少年患者为研究对象,进行眼表疾病指数(ocular surface disease index,OSDI)问卷调查,裂隙灯下行眼前节检查,格瓦拉-眼表综合分析仪Keratograph 5M检查眼表.根据OSDI干眼分级标准将患者分为干眼组(47例94眼)和正常组(201例402眼),分别对两组的眼表和睑板腺状况进行评估与比较.结果 近视儿童干眼发病率为18.95％.干眼组泪河高度为(0.23±0.03)mm,正常组为(0.22±0.03) mm,两组泪河高度均在正常范围内(泪河高度＞0.20 mm).干眼组和正常组的OSD1值分别为(27.02±14.35)分、(7.29±3.36)分,角膜荧光素染色评分分别为(3.51±1.67)分、(1.23±2.32)分,这两项指标在干眼组均明显高于正常组(P ＜0.001),NIBUT小于正常组(P ＜0.001).干眼组中睑板腺开口状况评分、睑板腺脂质分泌物性状评分、睑板腺缺失评分均明显高于正常组(均为P＜0.0001),纳入的248例近视青少年的睑板腺参数与角膜荧光素染色评分有正相关性(P＜0.0001),与非侵入性泪膜破裂时间有负相关性(P＜0.05),但与泪河高度无相关性(P＞0.05),OSDI值与非侵入性泪膜破裂时间呈负相关(rs=-0.982,P=0.000),与睑板腺的缺失评分呈正相关(rs=0.838,P =0.000).结论 睑板腺功能障碍是近视青少年人群干眼的重要病因之一,Keratograph 5M非侵入式眼表综合分析仪可无创性客观评价近视青少年患者眼表的情况.     

非侵入性眼表综合分析仪及Lipiview眼表面干涉仪评估儿童干眼的特点

目的　利用非侵入性眼表综合分析仪及Lipiview眼表面干涉仪评估儿童干眼的特点。方法　选取2017年1月至8月于天津医科大学眼科医院第一次确诊为干眼的儿童98例（186眼）,完成病史及眼表疾病指数（ocular surface disease index,OSDI）问卷后进行裂隙灯、泪膜破裂时间（tear film brek-up time,BUT）、泪液分泌试验（Schirmer Ⅰ test,S Ⅰ T）评估、非侵入性眼表综合分析仪及Lipiview眼表面干涉仪检查。结果　本组中159眼的BUT<5 s,30眼的SIt<5 mm。OSDI［13.63（9.09~15.91）分］与S Ⅰ T［（14.6±8.7）mm］无相关性（r=-0.119,P=0.259）;与BUT［3.00（2.00~5.00）s］无相关性（r=0.099,P=0.354）。第一次非侵入性泪膜破裂时间（first noninvasive tear film break-up time,NITBUT）,平均非侵入性泪膜破裂时间（average noninvasive tear film break-up time,NITBUTav）与OSDI均呈正相关性,NIBUT与NIBUTav呈高度正相关性（均为P<0.05）。NIBUT、NIBUTav与BUT均无相关性（r=0.112,P=0.059;r=0.159,P=0.455）。泪膜脂质层厚度（lipid layer thickness,LLT）、LLT最大值与NIBUTav呈正相关性;不完全眨眼比例与NIBUTav呈负相关性（均为P<0.05）;其余指标与OSDI和NITBUTav无相关性。LLT、LLT最大值、LLT最小值与睑板腺缺失评分均无相关性（r=-0.083、-0.028、-0.024,P=0.494、0.842、0.869）。结论　儿童干眼大多数属于短BUT型干眼,其BUT缩短,睑板腺缺失明显,LLT变薄。NIBUT与NIBUTav较BUT更客观准确,LLT较睑板腺缺失评分更有价值。非侵入性眼表综合分析仪及Lipview眼表面干涉仪可以客观准确评估儿童干眼的特点。     

儿童异常瞬目症56例分析

0引言由于受环境、饮食、气候等诸多因素的影响,儿童异常瞬目症近年来有逐渐增多的趋势[1]。我院2000-04/2002-10间共接诊频繁眨眼患儿56例,其中男41例,女15例,年龄2～11岁,现报道如下。     

儿童异常瞬目症与血铅水平相关分析

目的：了解异常瞬目症儿童其血铅水平是否存在异常。
　　方法：以“频繁眨眼”为主诉,诊断为异常瞬目征患儿为试验组。常规行视力、屈光学、裂隙灯、角膜荧光素染色、泪膜破裂时间检查,完善血铅及微量元素检查;对照组为同时期内在我院儿童保健科以“健康查体”为主诉的患儿,且除外血铅浓度结果、其他体查结果均为正常的儿童。并按性别分为男童组及女童组。比较试验组与对照组血铅浓度的变化。
　　结果：试验组共371例,男295例,女76例,平均年龄为男6.56±2.41岁,女6.08±2.82岁。对照组共300例,男186例,女114例,平均年龄为男6.99±3.01岁,女6.56±2.80岁。试验组中男童平均血铅浓度为63.82±24.56μg/L,正常组中男童平均血铅浓度为53.98±15.42μg/L。试验组与正常组男童的血铅浓度比较,血铅浓度偏高,差异具有显著性统计学意义(χ2=16.96,P<0.01)。试验组中女童平均血铅浓度为56.96±16.69μg/L,正常组中女童平均血铅浓度为48.18±12.35μg/L。试验组与正常组女童的血铅浓度比较,差异不具有统计学意义(χ2=5.77,P=0.56)。正常组<3岁组平均血铅浓度为48.73±11.67μg/L,3~6岁组平均血铅浓度为51.39±14.87μg/L,>6岁组平均血铅浓度为52.98±14.45μg/L。试验组儿童3岁以下组平均血铅浓度为56.57±17.89μg/L,3~6岁组平均血铅浓度为59.92±18.46μg/L,6岁以上组平均血铅浓度为67.00±32.55μg/L。其中0~3岁儿童试验组与对照组血铅浓度无统计学差异(χ2=3.54,P=0.17)。3~6岁年龄组及>6岁年龄组试验与对照组血铅浓度差异具有统计学意义(χ2=9.62,P=0.008;χ2=19.22,P=0.000)。将血铅浓度按<50,≥50μg/L且≤100μg/L,>100μg/L分为3个梯度,患儿出现异常瞬目发病率的相对危险度 RR 分为0.65,1.22,10.11。
　　结论：异常瞬目症患儿血铅浓度偏高,异常瞬目症发病率与血铅浓度成正相关。     

眼表综合分析仪在评价干燥综合征干眼中的临床意义

目的　探讨干燥综合征患者主观症状上的ＭｃＭｏｎｎｉｅ问卷评分、眼科检查和免疫学相关检查等辅助检查在评价干燥综合征干眼中的临床意义。方法　干燥综合征干眼患者共１０２例２０４眼,其中８３人有效完成ＭｃＭｏｎｎｉｅ问卷调查以评估主观症状;１０１人完成眼表综合分析仪等眼科相关检查,９４人完成免疫球蛋白ＩｇＧ、ＩｇＡ、ＩｇＭ、补体Ｃ３、补体Ｃ４和Ｃ反应蛋白的检查,７８人完成抗核抗体、抗α胞衬蛋白抗体、抗ＥＮＡ抗体-ＳＳＡ和抗ＥＮＡ抗体-ＳＳＢ的检查。采用ｔ检验和卡方检验比较相关数据之间的联系。结果　主观问卷评分与角膜荧光素染色结果（Ｐ＝０．０１９）、脂质层颜色（Ｐ＝０．０２７）有相关性。年龄与睑板腺数量有相关性（Ｐ＝０．０２２）。双眼脂质层颜色（Ｐ＝０．０１５）、角膜荧光素染色（Ｐ＝０．０２５）和泪河高度（Ｐ＝０．０３９）均与血清中ＩｇＧ水平存在相关性。血清中ＩｇＡ水平和ＢＵＴ结果有相关性（Ｐ＝０．０２２）。结论　泪膜脂质层、睑板腺、角膜的结构和功能的状态与患者的眼部症状关系密切,血清中免疫球蛋白水平与其眼科客观检查的指标有明显关联,可作为干燥综合征干眼的整体病情和泪膜角膜损伤程度的重要评估手段。     

儿童异常瞬目症的病因及治疗

儿童频繁眨眼,每分钟达15次以上,不伴有面肌痉挛和其他全身症状,具有相对独立的临床症状,无神经系统疾病,称为儿童多瞬症或儿童异常瞬目症;若合并眼部器质性病变或神经系统疾病者称为儿童瞬目综合征。该病为小儿眼科的常见病和多发病。儿童频繁瞬目的发病原因有眼部屈光不正、眼表及眼附属器疾患、不良生活及用眼习惯、铅污染、抽动障碍等全身疾患及心理因素。我们可认为大多数儿童的频繁瞬目首先由眼部疾患引起,神经、心理因素异常是加重或使其反复发生的重要原因。认识和鉴别儿童异常瞬目的病因,采取针对性治疗,可避免误诊而延误治疗。     

眼表综合分析仪评价干眼患者相关指标的临床分析

目的 评价眼表综合分析仪在干眼患者中的应用价值。方法 横断面研究。选择70例（135眼）干眼患者作为研究对象。检查指标包括眼表疾病指数（OSDI）评分、泪液分泌试验（SⅠT）、睑板腺分泌物性质检查,以及利用眼表综合分析仪系统--Keratograph 5M进行泪河高度测量、泪膜破裂时间（BUT）测定以及睑板腺检查。Keratograph 5M与传统检查方法之间的相关性、干眼患者睑板腺状况评分与OSDI评分及BUT的相关性用Pearson相关及线性回归进行分析,Keratograph 5M分析眼表状况的重测信度用组内相关系数评价。结果 70例（135眼）患者OSDI评分为（15.8±3.4）分,SⅠT为（6.0±7.7）mm,泪河高度为（0.27±0.13）mm,BUT为（7.9±5.5）s。睑板腺分泌物评分为（3.3±1.4）分,睑板腺缺失面积评分为（3.4±1.6）分。测得的BUT时间越短,SⅠT越短（r=0.474,P＜0.01）;泪河高度越低,SⅠT越短（r=0.432,P＜0.01）。睑板腺分泌物评分、睑板腺照相评分与OSDI评分呈正相关（r=0.673、0.752,P<0.05）,与BUT呈负相关（r=-0.638、-0.603,P<0.05）。眼表综合分析仪的检查结果具有较好的重测信度（ICC值在0.84~0.89之间）。结论 眼表综合分析仪能够直观地评价干眼患者眼表状况,是一种非接触性、无创、可重复性强的快速检查手段,具有实际临床应用价值。     

糖尿病患者干眼与眼表异常的相关分析

目的 通过糖尿病患者干眼与眼表异常的相关分析,探讨多种眼表因素异常在糖尿病干眼发病中的作用.方法 收集106例乌鲁木齐市汉族2型糖尿病患者存在的干眼症状及有关的眼表因素（泪液基础分泌、泪膜稳定性、泪液性状、角膜上皮完整性）检查结果,量化后进行单因素及多因素的非条件Logistic回归分析.结果 泪膜稳定性下降（P=0.020,OR=12.268）、泪液基础分泌量减少（P=0.007,OR=5.398）与糖尿病人干眼发生呈显著正相关,具有统计学意义.结论 泪膜稳定性下降、泪液基础分泌量减少在汉族2型糖尿病患者干眼的发病中起一定作用.     

120例儿童异常瞬目症的临床分析

目的探讨儿童异常瞬目症的病因及相关治疗。方法 120例（226只眼）3～15岁儿童,检查包括病史、视力、眼睑、结膜、角膜、眼底、屈光状态、BUT、Schirmer试验,发现病因并进行相关治疗。结果 120例（226只眼）中,52例（104只眼）屈光不正,66例（118只眼）有眼表疾患,其中慢性结膜炎40例（80只眼）,干眼10例（18只眼）,下睑倒睫5例（7只眼）,结膜结石3例（4只眼）,霰粒肿、麦粒肿6例（6只眼）,浅层点状角膜炎2例（3只眼）,针对病情治疗后异常瞬目消失100%。体质虚弱偏食患儿1例（2只眼）,多动症患儿1例（2只眼）。结论儿童异常瞬目症大多有原发病因,其中屈光不正和眼表疾患是主要病因,还应注意患者全身状况。早诊治及发现儿童眼部问题,可从根本上防止眼疾的发展,对异常瞬目症者伴有多动症者,应请神经科协助治疗。     

新型非侵入性眼表综合分析仪与传统干眼评估标准的对比研究

目的探讨Antares非侵入性眼表综合分析仪在于眼评估中的临床应用价值。方法采用观察性研究办法。对2015年5～7月于广州军区武汉总医院眼科准分子中心行屈光手术的近视患者34例（68只眼）,术前进行OSDI问卷调查,Antares非侵入性眼表综合分析仪检查（下称仪器法）以及临床相关检查（下称传统法）,包括泪膜破裂时间（BUT）及荧光素钠染色（FL）。仪器法及传统法检查结果均以2013年干眼临床诊疗专家共识为诊断及分级标准。分别将这三种方法的检查结果进行比较,从而对仪器的作用作出评价。结果仪器法测得的NIF-BUT、NIAvg-BUT、泪河高度,传统法测得的BUT均与OSDI干眼分级差异无统计学意义（P〉0．05）。干眼检出率：OSDI问卷为52．94％（18／34）,仪器法为17．65％（6／34）、传统法为85．29％（29／34）,这三种方法的检测结果均有显著的统计学意义（P〈0．05）。结论Antares眼表综合分析仪作为一种非接触性、无创的快速检查手段,可对临床干眼的诊断提供一定的参考依据,但其功能仍有待进一步改进、完善。     

Ocular Surface Microbiota in Diabetic Patients With Dry Eye Disease

PurposeTo investigate the ocular surface (OS) commensal bacteria profiles of patients with diabetes mellitus (DM) and dry eye disease (DED).MethodsIn the present study, subjects were assigned to four groups: 37 to the diabetic mellitus with dry eye disease (DM with DED) group, 22 to the diabetes mellitus (DM)-only group, 34 to the dry eye disease (DED)-only group, and 22 to the control group. Tear fluid was collected using Schirmer''s tear secretion test paper. 16S ribosomal ribonucleic acid (rRNA) gene sequencing was used to analyze the bacterial microbiota.ResultsThe DM with DED group showed the highest operational taxonomic unit (OTU) numbers and alpha diversity and the most different beta diversity. The groups shared the four most abundant phyla, accounting for over 96% of the total abundance. At the genus level, there were 10 types of overlap in the core microbiota in the groups. They showed significant differences between the groups. Additionally, the DM with DED group and the control group showed four unique core genera, respectively. Unclassified Clostridiales and Lactobacillus were the core microbiota members of the DM with DED group, the DM-only group, and the DED-only group, but not the control group.ConclusionsIn the present study, our results showed that the patients in the DM with DED group had a more complex and comprehensive ocular surface microbial composition. To the best of our knowledge, this is the first study to reveal the microbial profile of dry eye disease in patients with diabetes mellitus.     

Topical Quercetin and Resveratrol Protect the Ocular Surface in Experimental Dry Eye Disease

Purpose: To determine the anti-inflammatory effect of quercetin (QCT), resveratrol (RES), and their combination in a dry eye disease (DED) model.

Methods: 0.01% QCT, 0.1% RES, 0.01% QCT + 0.1% RES (QCT + RES) or vehicle were topically applied in a desiccating stress (DS) mice model. CD4⁺ T cells isolated from DS-exposed mice were transferred to athymic recipient mice. Corneal fluorescein staining, tear production, and tear cytokine levels were evaluated in DS-exposed mice, and conjunctival CD4⁺ T cell infiltration was evaluated in recipient mice.

Results: QCT (p < 0.001) and QCT + RES (p < 0.05) reduced corneal staining in DS-exposed mice. IL-1α tear concentration was reduced by QCT, RES, and QCT + RES (p < 0.05, 0.01 and 0.01, respectively) compared to DS + vehicle mice. CD4⁺ T cells increased in recipients of DS-exposed mice (p < 0.05) and were lower in recipients of QCT- and RES-treated mice (p < 0.05).

Conclusion: The anti-inflammatory effect of QCT, RES, and QCT + RES on DED-experimental model suggests that their topical application could be used for DED treatment.     

主导眼与眼部疾病的相关性研究进展

主导眼是双眼中具有视觉输入优势的一眼,又称优势眼、主视眼,通常分为注视性主导眼、知觉性 主导眼和运动性主导眼。关于主导眼的研究一直未曾间断,近年来有学者对主导眼的形成机制、测量 方法及与相关疾病的关系进行了大量研究。现笔者就主导眼与眼部疾病的相关性研究现状进行综述。     

对眼表疾病、眼睑炎和干眼症患者的聚集性分析

目的：为眼睑炎和干眼症开发一种基于含有多种客观生理学检查的课题大样本树模型的分类系统。方法：我们评价了513个进行了泪容量、泪流量和泪循环以及干眼症的schirmer试验（眼分泌试验）检查的课题，包括一些健康的和一些眼睑炎和干眼症。用睑板腺油脂压出法测定油脂的容量、粘稠度、蒸发率以及睑板腺排空后的眼睑透照试验等评价睑板腺的功能。我们将这些数据进行了聚集性分析，描绘出分类树图。     

Evaluation of Corneal Biomechanical Properties Following Penetrating Keratoplasty Using the Ocular Response Analyzer

Purpose

To evaluate corneal biomechanical properties in eyes that had previously undergone penetrating keratoplasty (PK) using the ocular response analyzer (ORA).

Methods

We recruited 26 patients who had received unilateral PK. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc) were measured with the ORA and were compared to the measurements from the contralateral eyes that did not undergo PK.

Results

The CH was 8.95±2.59 mmHg in eyes that underwent PK and 9.78±1.45 mmHg in the contralateral eyes that did not undergo PK (p=0.077). The CRF was 10.26±2.64 mmHg in post-PK eyes and 9.75±1.45 mmHg in the contralateral eyes (p=0.509), and the CH-CRF was significantly smaller in post-PK eyes (-1.31±2.32 mmHg in post-PK eyes vs. 0.03±0.88 mmHg in fellow eyes, p=0.016). The IOPg and IOPcc were significantly higher in the PK group than they were in the control group. The IOPcc''s were 20.81±7.81 mmHg and 16.27±2.49 mmHg in post-PK and control eyes, respectively (p=0.011); and the IOPg''s were 19.22±7.34 mmHg and 15.07±3.03 mmHg in post-PK and control eyes, respectively (p=0.019). The IOPcc-g''s were 1.59±2.81 mmHg and 1.21±1.30 mmHg in post-PK and control eyes, respectively (p=0.412), and the central corneal thickness (CCT)''s were 489.11±90.60 µm and 556.24±42.84 µm in post-PK and control eyes, respectively (p=0.068).

Conclusions

Following PK, CH tended to decrease while CRF tended to increase, significantly decreasing CH-CRF. A significantly higher intraocular pressure and a thinner CCT following PK may have contributed to the observed changes in these corneal biomechanical parameters.     

睑板腺分泌物与干眼症关系的研究

目的:了解异常睑板腺分泌物和干眼症的关系。方法:在门诊连续观察68例共136眼。常规检查视力和矫正视力、眼球前段和眼底检查。进行泪膜破裂时间(BUT),SchirmerⅠ试验和角膜虎红染色(rb)并评分,观察记录睑板腺分泌物的性质。按病情轻重将干眼症分为轻度和重度。结果:蛋清样分泌物28眼,奶黄样分泌物26眼,颗粒状分泌物30眼,牙膏状分泌物52眼。干眼症指标3项显示,在蛋清样,奶黄样,颗粒状和牙膏状睑板腺分泌物中,BUT积分和rb积分呈阶梯状依次增高,牙膏状分泌物组的BUT和rb积分明显高于其它3组,(两两比较,P均<0.01)。各组SchirmerⅠ积分均在1分以下,组间无差别。有54眼(40%)符合干眼症诊断标准,各组患干眼症的构成比依次升高为:蛋清样(2/28)7.1%;奶黄样(4/26)15%;颗粒状(8/30)27%;牙膏状(40/52)77%。颗粒状分泌物发生干眼症高于蛋清样组(P<0.05),而牙膏状分泌物发生干眼症明显高于其它3组(P<0.01)。蛋清样和奶黄样分泌物组无重度干眼症患者,8眼颗粒状分泌物中重度干眼症占2眼,而40眼牙膏状分泌物中19眼发生重度干眼症。牙膏状分泌物发生重度干眼症高于非牙膏状分泌物(P<0.05)。结论:异常睑板腺分泌物影响眼表面的稳定性,其中牙膏状分泌物患者易患干眼症,干眼症程度较其它分泌物组重。     

眼针疗法治疗“气阴两虚型”干眼的临床研究

目的：观察眼针疗法治疗“气阴两虚型”干眼的临床疗效及其作用机制。方法：前瞻性随机对照研 究。收集2021年1—4月于辽宁中医药大学附属第二医院确诊为“气阴两虚型”干眼患者74例,通 过随机数字表法将74例患者分为眼针疗法组和常规针法组,各37例。常规针法组给予常规针刺治 疗,主穴为攒竹、四白、阳白、丝竹空、太阳;配穴为太溪、合谷、足三里、三阴交。眼针疗法组予 以眼针治疗,取肝区、肺区、脾区、肾区四穴治疗。疗程均为14 d。记录2组治疗前后眼表疾病指 数（OSDI）评分;检测无表麻泪液分泌试验（SⅠT）和角膜荧光素染色（CFS）;使用K5M眼表分析仪 采集首次泪膜破裂时间（NIBUTf）和平均泪膜破裂时间（NIBUTav）。数据采用t检验、Wilcoxon秩和 检验、χ2 检验进行统计分析。结果：常规针法组与眼针疗法组的OSDI评分、SⅠT、CFS、NIBUTf、 NIBUTav在组内治疗前后比较,差异均有统计学意义（均P<0.05）。治疗后2组患者的OSDI评分、 SⅠT、NIBUTf、NIBUTav比较,差异均有统计学意义（均P<0.05）;治疗后组间CFS比较差异无统计 学意义。结论：常规针法与眼针疗法均能有效治疗“气阴两虚型”干眼,眼针疗法在改善干眼的眼 表症状、泪液分泌及泪膜破裂时间方面优于常规针法治疗,其优效性和依从性更高。     

Age-related Defects in Ocular and Nasal Mucosal Immune System and the Immunopathology of Dry Eye Disease

Dry eye disease (DED) is a prevalent public health concern that affects up to 30% of adults and is particularly chronic and severe in the elderly. Two interconnected mechanisms cause DED: (1) an age-related dysfunction of lacrimal and meibomian glands, which leads to decreased tear production and/or an increase in tear evaporation; and (2) an age-related uncontrolled inflammation of the surface of the eye triggered by yet-to-be-determined internal immunopathological mechanisms, independent of tear deficiency and evaporation. In this review we summarize current knowledge on animal models that mimic both the severity and chronicity of inflammatory DED and that have been reliably used to provide insights into the immunopathological mechanisms of DED, and we provide an overview of the opportunities and limitations of the rabbit model in investigating the role of both ocular and nasal mucosal immune systems in the immunopathology of inflammatory DED and in testing novel immunotherapies aimed at delaying or reversing the uncontrolled age-related inflammatory DED.