摘要目的:采用2种不同干眼检查设备评估患者配戴夜戴型角膜塑形镜后泪膜质量的变化.方法:前瞻性临床研究.选取2016年1月至2017年10月于中国医科大学附属第四医院眼科就诊并验配角膜塑形镜的患者共计118例,选取右眼数据用于统计.年龄8～18(11.8±2.5)岁.应用Keratograph 5M眼表综合分析仪观察患者在戴镜前及戴镜后1、3、6个月的泪河高度(TMH)、非侵入首次泪膜破裂时间[NIBUT (f)]和平均泪膜破裂时间[NIBUT (av)];同时应用DR-1型干眼仪测量患者戴镜后不同时间点泪膜脂质层光干涉图像.采用重复测量方差分析和Pearson相关分析进行数据统计.结果:TMH:戴镜后1、3、6个月与戴镜前比较差异均无统计学意义.NIBUT (f)和NIBUT (av):戴镜后1个月的泪膜破裂时间和戴镜前比较明显缩短(均P＜0.001),之后各时间点和戴镜前比较差异无统计学意义.泪膜脂质层分级:配戴角膜塑形镜后1个月较戴镜前有明显下降(P＜0.001),之后各时间点与戴镜前比较差异无统计学意义.泪膜脂质层分级与泪膜破裂时间[NIBUT (f)、NIBUT(av)]之间具有相关性(r=-0.145,P=0.011;r=-0.147,P=0.019).结论:青少年患者配戴角膜塑形镜后泪液的分泌量未受影响,但在早期降低了泪膜稳定性,随时间延长可逐渐恢复.Keratograph 5M眼表综合分析仪和DR-1型干眼仪可从不同层面上辅助干眼疾病的诊断.

abstractsObjective:To investigate the changes due to wearing long-term overnight orthokeratology lenses on the stability of tear film as measured by different diagnostic devices.Methods:This was a prospective clinical study.One hundred eighteen patients,who were treated with orthokeratology lenses at The Fourth Affiliated Hospital of the China Medical University from January 2016 to October 2017,were included in the study.The patients' ages ranged from 8 to 18 years (11.8±2.5).Measurements of tear meniscus height (TMH),noninvasive first breakup time [NIBUT (f)] and noninvasive average breakup time [NIBUT (av)]in each subject were obtained with a Keratograph 5M.Measurements were taken before lens wear and 1,3,and 6 months after lens wear.The lipid layer interference patterns of the lacrimal film were divided by the DR-1 Tearscope Plus.Data were analyzed by repeated measures analysis of variance and by Pearson correlation analysis.Results:1.Tear meniscus height:The TMH results showed a consistent but not statistically significant difference before and after wearing orthokeratology lenses.2.NIBUT(f)and NIBUT(av):NIBUT had decreased by the time of the 1-month visit (P＜0.001);after that,all of the above changes decreased slightly and then stabilized.3.Grades of tear film quality.There was a decrease in the stability of tear film from before lens wear to 1 month after lens wear (P＜0.001),but there were no significant grade differences at 3 months and 6 months compared to prior measurements.4.There was a small correlation between the variation in the lacrimal film lipid layer interference patterns and the BUT measured by different diagnostic devices during the follow-up study (r=-0.145,P=0.011;r=-0.147,P=-0.019).Conclusions:Wearing contact lenses does not induce tear deficiency.It can result in decreasing the stability of tear film during the early stages of lens wear,but stability is gradually restored after that.Oculus keratography and DR-1 Tearscope Plus can assist in the diagnosis of dry eye diseases at different levels.