背景 干眼的发病与泪膜的稳定性密切相关,干眼患者多伴有视觉干扰症状,因此从视觉质量角度评估泪膜稳定性并探讨泪膜稳定性相关客观参数动态变化对干眼的诊断具有重要的临床意义. 目的 基于OQAS-Ⅱ系统测定轻中度干眼客观散射指数(OSI)、调制传递函数截止频率(MTF cut off)、100％对比度下客观视力(OVA)随泪膜变化的动态改变,探讨这些参数对于眼的鉴别诊断价值. 方法 采用临床诊断性试验研究方法,连续纳入2013年12月至2014年5月于天津市眼科医院确诊的轻中度于眼患者42例42眼,诊断标准依据《2013年干眼临床诊疗专家共识》中的标准,并纳入同期年龄、性别匹配的健康志愿者29人29眼作为对照.采用OQAS-Ⅱ系统动态记录受检者在15 s不瞬目情况下视网膜图像,分别记录检测过程中0、5、10、15s的OSI、MTF cut off和OVA,计算这3个参数15s检测值与0 s检测值的差值(△OSI、△MTF cut off、△OVA),比较2个组间3个参数随检测时间变化的动态改变,采用受试者工作特征曲线(ROC)分析△OSI、△MTF cut off、△OVA对干眼鉴别诊断的敏感性和特异性. 结果 轻中度干眼组受检眼5、10和15 s检测的OSI值均明显高于0s值,且高于相应时间点健康对照组测定值,差异均有统计学意义(均P＜0.05);轻中度干眼组5、10和15s受检眼MTF cut off值和OVA值均明显低于组内0s测定值及相应时间点健康对照组测定值,差异均有统计学意义(均P＜0.05).轻中度干眼组△OSI、△MTF cut off、△OVA值分别为1.03±1.53、(-8.37±9.64)c/d和-0.30±0.32,均明显大于健康对照组的0.06±0.16、(-0.37±5.27)c/d和-0.03±0.18,差异均有统计学意义(t=4.10、-5.19、-5.28,均P＜0.05).△OSI、△MTF cut off、△OVA的ROC曲线下面积分别为0.90、0.79和0.78.当△OSI取诊断界值为0.3时,敏感度为78.6％,特异度为93.1％. 结论 轻中度干眼患者包括散射在内的视觉质量参数随时间延长逐渐下降,而正常眼均相对稳定.OQAS-Ⅱ系统检测结果可反映泪膜动态稳定性,对干眼的鉴别诊断及评估干眼患者视觉质量的受影响程度有重要的临床应用价值.%Background The progenesis and development of dry eye is closely associated with the stability of tear-film.Dry eyes often show the visual disturbance.Therefore,to evaluate the stability of tear-film based on visual quality and explore the relevant dynamic vision change in dry eyes is of important significance.Objective The aim of this study was to evaluate the dynamic changes of objective scattering index (OSI),modulation transfer function cut off (MTF cut off),objective visual acuity (OVA) with tear-film in the patients with mild or moderate dry eye disease using Optical Quality Analysis System.Methods A clinical diagnosis test was performed.Forty-two eyes of 42 consecutive patients with mild or moderate dry eyes were included in Tianjin Eye Hospital from December 2013 to May 2014 based on ‘ The Clinical Diagnosis and Treatment Recommendations for Dry Eye from Consensus of Expert Advice in 2013’,and 29 normal eyes of age-and gender-matched 29 healthy volunteers were simultaneously included as the healthy control group.The dynamic retinal images under non-blinking condition during 15 seconds were recorded by OQAS-Ⅱ system,and the OSI,MTF cut off and OVA values at 0,5,10 and 15 seconds were obtained,and the differences of OSI,MTF cut off and OVA between 0 second and 15 seconds were calculated (△OSI,△MTF cut off,△OVA).The dynamic changes of △OSI,△MTF cut off and △OVA with time were evaluated.The sensitivity and specificity of △OSI,△MTF cut off and △OVA for the differential diagnosis of dry eyes were analyzed by receiver operating characteristic curve (ROC curve).Results The OSI values at 5,10 and 15 seconds in the mild or moderate dry eye group were significantly higher than those at 0 second or those in the healthy control group (all at P＜0.05),and the MTF cut off values and OVA values at 5,10 and 15 seconds in the mild or moderate dry eye group were significantly lower than those at 0 second or those in the healthy control group (all at P＜0.05).The △OSI,△MTF cut off and △OVA values were 1.03±1.53,(-8.37±9.64)c/d and-0.30±0.32 in the mild or moderate dry eye group,which were significantly higher than 0.06± 0.16,(-0.37 ± 5.27) c/d and-0.03 ± 0.18 in the healthy control group (t=4.10,-5.19,-5.28,all at P＜0.05).The area under ROC curve was 0.90,0.79 and 0.78 in △OSI,△MTF cut off and △OVA,respectively.The sensitivity and specificity of △OSI was 78.6％ and 93.1％ respectively at the diagnostic cut off of 0.3.Conclusions The optical quality parameters related with tear-film stability are gradually reduced with extending of time in mild or moderate dry eyes,but they are stable in healthy eyes.The detecting outcomes by OQAS-Ⅱ system can reflect the dynamic status of tear-film,and this method is of important clinical value for the differential diagnosis and optical quality evaluation in dry eyes.
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