目的 评价眼前节OCT(AS-OCT)测量的下泪新月参数在于眼诊断中的应用.方法 采用前瞻性随机临床对照研究,选择2015年5月至2016年10月于山西省眼科医院就诊的干眼患者113例226眼,同期纳入206人410眼健康志愿者进行对照.应用RTVue-XR测量全部受试者的下泪新月高度(LTMH)、下泪新月面积(LTMA)、下泪新月深度(LTMD)、中央6 mm内的角膜上皮厚度(CET)及角膜厚度.比较2个组受试人群的测量结果并绘制受试者工作特征(ROC)曲线,将干眼组与对照组分为＞20～30岁、＞30～40岁、＞40～50岁、＞50～60岁4个年龄段,比较各年龄段2个组下泪新月参数变化,通过线性回归方程分析下泪新月随年龄的变化情况.结果 干眼组LTMH、LTMD、LTMA值分别为(216.08±67.26) μm、(116.50±29.13) μm、(0.012 9±0.006 7)mm2,均小于对照组的(333.71±50.38) μm、(139.56±28.76) μm、(0.026 6±0.007 4) mm2,差异均有统计学意义(均P＜0.05).干眼组中央2、2～5和5～6 mm区域内的各个象限CET均明显小于对照组,差异均有统计学意义(均P＜0.05).除中央5～6 mm区域内上方、鼻上方1/8象限及中央2～5 mm范围内上方1/8象限干眼组与对照组的角膜厚度比较,差异无统计学意义(均P＞0.05),其余各象限干眼组角膜厚度值均小于对照组,差异均有统计学意义(均P＜0.05).LTMH、LTMD、LTMA、中央2 mm CET和中央2mm角膜厚度截断值分别为269.83 μm、122.02 μm、0.023 2 mm2、54.16 μm和531.50 μm;灵敏度分别为85.4％、88.9％、96.5％、77.0％和66.8％;特异度分别为91.7％、70.5％、75.1％、56.8％和59.8％.各年龄段干眼组LTMA、LTMH、LTMD值均明显低于对照组,差异均有统计学意义(均P＜0.05).线性回归分析结果显示,对照组年龄每增长1岁,LTMH减少3.966 μm,LTMD减少2.381 μm;干眼组年龄每增长1岁,LTMH减少1.293 μm.与对照组比较,干眼组LTMA缩小,边界线不同程度模糊且连贯性差,泪液混浊度增加. 结论 AS-OCT能够客观反映下泪新月参数的形态、中央CET和中央角膜厚度变化.正常人的LTMH、LTMD随年龄的递增有递减趋势.LTMA和LTMH对干眼的诊断效力较高,有望成为干眼筛查的重要方法之一.%Objective To evaluate the application of the lower tear meniscus parameters measured by anterior segment optical coherence tomography (AS-OCT) in dry eye diagnosis.Methods A prospective randomized clinical controlled study was conducted.One hundred and thirteen dry eye patients (226 eyes) and 206 healthy volunteers (410 eyes) were enrolled from May 2015 to October 2016 in Shanxi Eye Hospital.The lower tear meniscus height (LTMH),lower tear meniscus area (LTMA),lower tear meniscus depth (LTMD),the corneal epithelial thickness (CET) at central 6 mm and the corneal thickness at central 6 mm were measured by RTVue-XR.The measurement results of the two groups were compared and the ROC curve was drawn.The dry eye group and the control group were divided into four age groups:＞20-30 years old,＞30-40 years old,＞40-50 years old and ＞50-60 years old.The changes of the parameters of the tear crescent in different age groups were compared.The changes of the lower tear meniscus with age were analyzed by linear regression equation.This study was approved by the Ethics Committee of Shanxi Eye Hospital.All operations were performed in accordance with the Helsinki Declaration,and written informed consent was obtained from each subject prior to any medical examination.Results The values of LTMH,LTMD and LTMA in dry eye group were (216.08±67.26) μm,(116.50±29.13) μm,(0.012 9±0.006 7) mm2,respectively,which were lower than (333.71±50.38) μm,(139.56±28.76) μm,(0.026 6±0.007 4)mm2 in control group,with statistical significance between the two groups (all at P＜0.05).The CET values of each quadrant in the central area of 2 mm,2-5 mm and 5-6 mm in the dry eye group were significantly lower than those in the control group,with statistically significant differences between the two groups (all at P＜0.05).The corneal thickness of central 5-6 mm region,1/8 above the superior nasal quadrant in the central range of 2-5 mm and 1/8 above the superior quadrant was not statistically significant between the two group (all at P＞0.05);the corneal thickness values of the other quadrant in dry eye groups were lower than those in control group,the differences were statistically significant (all at P＜0.05).The cut-off values of LTMH,LTMD,LTMA,CET at central 2 mm and corneal thickness at central 2 mm were 269.83 μm,122.02 μm,0.023 2 mm2,54.16 μm,531.50 μm,respectively,the sensitivity were 85.4％,88.9％ 96.5％,77.0％,66.8％,respectively;the specificity were 91.7％,70.5％,75.1％,56.8％,59.8％,respectively.The values of LTMA,LTMH and LTMD in each age group of dry eye group were significantly lower than those of the control group (all at P＜0.05).Linear regression analysis showed that LTMH was decreased by 3.966 μm and LTMD was decreased by 2.381 μm along with the increase of 1 year age in the control group,while LTMH was decreased by 1.293 μm along with the increase of 1 year age in the dry eye group.Compared with the control group,the area of the lower tear crescent image in the dry eye group was reduced,the boundary line was blurred and the coherence was poor in varying degrees,and the turbidity of the tear was increased.Conclusions AS-0CT can objectively reflect the shape of the lower tear meniscus parameters,central CET and central corneal thickness changes.The LTMH and LTMD of normal people are decreased with the increase of age.LTMA and LTMH have high diagnostic efficacy for dry eye and are expected to become one of the important methods for dry eye screening.
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