利用Pentacam测量泪液清除率及泪膜厚度图的临床研究

发布时间：2018-06-13 05:10

本文选题：Pentacam + 泪液清除率　；参考：《复旦大学》2010年硕士论文

【摘要】： 第一部分利用Pentacam测量泪液荧光素清除率的新方法目的报道一种利用Pentacam Scheimpflug拍摄系统定量检测泪液荧光素清除率(TFCR)的新方法。方法Pentacam能够测量反射光强度(RLI)从而判断眼部屈光介质的混浊程度。首次Pentacam扫描获得基线角膜RLI,然后吸取2μl1%荧光素钠滴入结膜囊下穹窿,分别于3分钟、5分钟后,再次行Pentacam扫描获得角膜泪膜联合RLI。角膜泪膜联合RLI经校正后(减去基线角膜RLI),即得出泪膜RLI。通过测量泪膜RLI,可以评估泪液荧光素清除率。收集30例主诉干眼症状的患者以及30例性别年龄相匹配的正常人。每例被检者需要进行裂隙灯显微镜观察、SchirmerⅠ试验及Pentacam泪液荧光素清除率检查。结果有干眼症状的患者Schirmer值(7.0±6.4 mm/5min,z=-4.266,P0.0001)较无症状的正常人显著降低(18.4±9.6 mm/5min)。有干眼症状的患者泪液荧光素清除显著延迟(3分钟后泪膜RLI维持在41.1±14.5,z=5.271,P0.0001；5分钟后泪膜RLI依然维持在28.7±10.9,z=4.894,P0.0001),而正常人泪液荧光素清除较迅速(3分钟后泪膜RLI为17.9±13.5；5分钟后泪膜RLI为11.0±10.7)。研究中发现,泪膜RLI与Schirmer值呈显著负相关(3分钟后泪膜RLI,Spearman's rho=-0.45,P=0.0003；5分钟后泪膜RLI,Spearman's rho=-0.47,P=0.0002)。本研究采用ROC曲线分析不同检查方法鉴别干眼症状的能力,结果显示：3分钟后泪膜RLI的AUC为0.8961；5分钟后泪膜RLI的AUC为0.8678;SchirmerⅠ试验的AUC为0.8194。并且,当3分钟后泪膜RLI取临界值31.6时,泪液清除率试验的敏感度为80%,特异度为93%。结论Pentacam TFCR测量试验是能够定量检测泪液清除率的简便实用的有效方法,具有推广应用于临床的前景。新方法将有助于深入研究生理及病理条件下的泪液清除率特点。第二部分利用Pentacam测量角膜前泪膜厚度图的新方法目的报道一种利用Pentacam Scheimpflug拍摄系统测量人眼角膜前泪膜厚度图的新方法。方法微量荧光素辅助下,泪膜可在Pentacam Scheimpflug拍摄中显影,此时Pentacam角膜测厚包含泪膜厚度在内。本研究中收集20例门诊确诊为干眼的患者以及20例性别年龄相匹配的正常人。选择每例被检者右眼,分别于荧光素使用前和滴入结膜囊1μl 0.1%荧光素钠后行Pentacam扫描。Pentacam系统内置软件可比较每只眼荧光素使用前后角膜厚度图的差异从而得到泪膜厚度图。评估角膜中央泪膜厚度,并且分析泪膜厚度图的空间分布类型。结果干眼患者角膜中央泪膜厚度平均值(22.2±4.5μm)小于正常眼泪膜厚度(24.7±3.9μm,t=-1.9280,P=0.0614)。研究中发现,根据泪膜空间分布特点,可将泪膜厚度图分为三种类型：1型“向上增厚型”,2型“均匀分布型”,3型“向下增厚型”。正常眼的泪膜厚度图包括1型(8幅,40%),2型(8幅,40%),3型(4幅,20%),而干眼泪膜厚度图包括1型(14幅,70%),2型(4幅,20%),3型(2幅,10%)。干眼泪膜厚度图中1型“向上增厚型”所占比例趋于更高,尽管干眼与正常眼两组间差异尚缺乏显著性(CMHχ2= 2.9630, P=0.0852)。结论Pentacam泪膜测厚新方法可以非侵犯性地测量人眼角膜前任一位置泪膜厚度,新方法将有助于深入研究生理及病理条件下角膜表面泪膜的空间分布规律。
[Abstract]:The first part is a new method of measuring tear clearance rate by Pentacam.
Objective to report a new method for quantitative detection of tear fluorescein clearance (TFCR) using Pentacam Scheimpflug capture system.
Methods Pentacam was able to measure the intensity of reflected light (RLI) to determine the degree of turbidity in the refractive media of the eye. The baseline corneal RLI was obtained by the first Pentacam scan and then 2 u l1% fluorescein sodium was absorbed into the conjunctival subsac fornix. After 3 minutes, and 5 minutes later, the corneal tear film combined with the RLI. corneal tear film combined with RLI correction was obtained again. After subtracting the RLI of the baseline cornea, that is, the tear film RLI. can be measured by measuring the tear film RLI, and the tear fluorescein clearance rate can be evaluated. 30 patients who have complained of dry eye symptoms and 30 normal men with matched sex and age are collected. Each case needs a slit light microscope, a Schirmer I test and a Pentacam tear fluorescein clearance test.
Results the Schirmer values of patients with dry eye symptoms (7 + 6.4 mm/5min, z=-4.266, P0.0001) were significantly lower than those of the asymptomatic normal people (18.4 + 9.6 mm/5min). The lacrimal fluorescein clearance in patients with dry eye symptoms was significantly delayed (3 minutes after 3 minutes, the tear film RLI was maintained at 41.1 + 14.5, z=5.271, P0.0001; and 5 minutes later, tear film RLI remained at 28.7 + 10.9, z=4.894. " P0.0001), while normal human tear fluorescein clearance was faster (3 minutes later, tear film RLI was 17.9 + 13.5; tear film RLI was 11 + 10.7 after 5 minutes. The tear film RLI was negatively correlated with Schirmer value (3 minutes later, RLI, Spearman's rho=-0.45, P=0.0003; tear film RLI, Spearman's rho=-0.47) after 5 minutes. The OC curve analyzed the ability to identify dry eye symptoms by different methods. The results showed that the AUC of RLI in tear film was 0.8961 after 3 minutes, AUC of RLI in tear film was 0.8678 after 5 minutes, AUC of Schirmer I test was 0.8194. and when the critical value of tear film RLI was 31.6 after 3 minutes, the sensitivity of tear clearance test was 80% and specificity was 93%..
Conclusion the Pentacam TFCR measurement test is a simple and practical and effective method for the quantitative detection of tear clearance, and has the potential to be applied to the clinic. The new method will be helpful to the study of tear clearance characteristics under physiological and pathological conditions.
The second part is a new method of measuring anterior tear film thickness by Pentacam.
Objective to report a new method for measuring the tear film thickness of human cornea using Pentacam Scheimpflug capture system.
Methods with the help of micro fluorescein, the tear film could be developed in Pentacam Scheimpflug. At this time, the thickness of the Pentacam cornea was included in the thickness of the tear film. In this study, 20 patients with dry eyes and 20 normal men with matched sex and age were collected. The right eye of each case was selected before and in the conjunctiva before and after the use of fluorescein. The internal software of the Pentacam scan.Pentacam system after 1 L 0.1% fluorescein sodium could be used to compare the thickness of the tear film by comparing the corneal thickness of each eye before and after the use of fluorescein. The thickness of the central tear film was evaluated and the spatial distribution of the tear film thickness was analyzed.
Results the average thickness of the central tear film thickness (22.2 + 4.5 m) in dry eyes was less than that of normal tear film thickness (24.7 + 3.9 m, t=-1.9280, P=0.0614). It was found that the tear film thickness map could be divided into three types according to the spatial distribution characteristics of tear film: 1 type "upward thickening", 2 "uniform distribution", and 3 "downward thickening". The tear film thickness map of the eyes included type 1 (8, 40%), 2 (8, 40%), 3 (4, 20%), and the dry tear film thickness map included 1 (14, 70%), 2 type (1). The proportion of "upward thickening" in the dry tear film thickness chart tended to be higher, although there was no significant difference between the dry eyes and the normal eyes (CMH x 2=, P=0 .0852).
Conclusion the new method of Pentacam tear film thickness measurement can be used to measure the tear film thickness of the anterior cornea. The new method will help to study the spatial distribution of the tear film on the surface of the cornea under the physiological and pathological conditions.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R77

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