本文選題：Pentacam + 淚液清除率　； 參考：《復(fù)旦大學(xué)》2010年碩士論文

【摘要】： 第一部分利用Pentacam測(cè)量淚液熒光素清除率的新方法 目的報(bào)道一種利用Pentacam Scheimpflug拍攝系統(tǒng)定量檢測(cè)淚液熒光素清除率(TFCR)的新方法。 方法Pentacam能夠測(cè)量反射光強(qiáng)度(RLI)從而判斷眼部屈光介質(zhì)的混濁程度。首次Pentacam掃描獲得基線角膜RLI,然后吸取2μl1%熒光素鈉滴入結(jié)膜囊下穹窿,分別于3分鐘、5分鐘后,再次行Pentacam掃描獲得角膜淚膜聯(lián)合RLI。角膜淚膜聯(lián)合RLI經(jīng)校正后(減去基線角膜RLI),即得出淚膜RLI。通過測(cè)量淚膜RLI,可以評(píng)估淚液熒光素清除率。收集30例主訴干眼癥狀的患者以及30例性別年齡相匹配的正常人。每例被檢者需要進(jìn)行裂隙燈顯微鏡觀察、SchirmerⅠ試驗(yàn)及Pentacam淚液熒光素清除率檢查。 結(jié)果有干眼癥狀的患者Schirmer值(7.0±6.4 mm/5min,z=-4.266,P0.0001)較無癥狀的正常人顯著降低(18.4±9.6 mm/5min)。有干眼癥狀的患者淚液熒光素清除顯著延遲(3分鐘后淚膜RLI維持在41.1±14.5,z=5.271,P0.0001；5分鐘后淚膜RLI依然維持在28.7±10.9,z=4.894,P0.0001),而正常人淚液熒光素清除較迅速(3分鐘后淚膜RLI為17.9±13.5；5分鐘后淚膜RLI為11.0±10.7)。研究中發(fā)現(xiàn),淚膜RLI與Schirmer值呈顯著負(fù)相關(guān)(3分鐘后淚膜RLI,Spearman's rho=-0.45,P=0.0003；5分鐘后淚膜RLI,Spearman's rho=-0.47,P=0.0002)。本研究采用ROC曲線分析不同檢查方法鑒別干眼癥狀的能力,結(jié)果顯示：3分鐘后淚膜RLI的AUC為0.8961；5分鐘后淚膜RLI的AUC為0.8678;SchirmerⅠ試驗(yàn)的AUC為0.8194。并且,當(dāng)3分鐘后淚膜RLI取臨界值31.6時(shí),淚液清除率試驗(yàn)的敏感度為80%,特異度為93%。 結(jié)論P(yáng)entacam TFCR測(cè)量試驗(yàn)是能夠定量檢測(cè)淚液清除率的簡(jiǎn)便實(shí)用的有效方法,具有推廣應(yīng)用于臨床的前景。新方法將有助于深入研究生理及病理?xiàng)l件下的淚液清除率特點(diǎn)。 第二部分利用Pentacam測(cè)量角膜前淚膜厚度圖的新方法 目的報(bào)道一種利用Pentacam Scheimpflug拍攝系統(tǒng)測(cè)量人眼角膜前淚膜厚度圖的新方法。 方法微量熒光素輔助下,淚膜可在Pentacam Scheimpflug拍攝中顯影,此時(shí)Pentacam角膜測(cè)厚包含淚膜厚度在內(nèi)。本研究中收集20例門診確診為干眼的患者以及20例性別年齡相匹配的正常人。選擇每例被檢者右眼,分別于熒光素使用前和滴入結(jié)膜囊1μl 0.1%熒光素鈉后行Pentacam掃描。Pentacam系統(tǒng)內(nèi)置軟件可比較每只眼熒光素使用前后角膜厚度圖的差異從而得到淚膜厚度圖。評(píng)估角膜中央淚膜厚度,并且分析淚膜厚度圖的空間分布類型。 結(jié)果干眼患者角膜中央淚膜厚度平均值(22.2±4.5μm)小于正常眼淚膜厚度(24.7±3.9μm,t=-1.9280,P=0.0614)。研究中發(fā)現(xiàn),根據(jù)淚膜空間分布特點(diǎn),可將淚膜厚度圖分為三種類型：1型“向上增厚型”,2型“均勻分布型”,3型“向下增厚型”。正常眼的淚膜厚度圖包括1型(8幅,40%),2型(8幅,40%),3型(4幅,20%),而干眼淚膜厚度圖包括1型(14幅,70%),2型(4幅,20%),3型(2幅,10%)。干眼淚膜厚度圖中1型“向上增厚型”所占比例趨于更高,盡管干眼與正常眼兩組間差異尚缺乏顯著性(CMHχ2= 2.9630, P=0.0852)。 結(jié)論P(yáng)entacam淚膜測(cè)厚新方法可以非侵犯性地測(cè)量人眼角膜前任一位置淚膜厚度,新方法將有助于深入研究生理及病理?xiàng)l件下角膜表面淚膜的空間分布規(guī)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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R77

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