A standardized visual scale for evaluation of tear fluorescein clearance
A standardized visual scale for evaluation of tear fluorescein clearance
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DOI：
10.1016/s0161-6420(00)00101-9
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发表时间：
2000-07-01
期刊：
影响因子：
13.7
通讯作者：
Pflugfelder, S
中科院分区：
文献类型：
--
作者：
Macri, A;Rolando, M;Pflugfelder, S
目的：评价一种有效的荧光素清除试验(荧光素清除试验)与一种新开发的、临床实用的标准化视力量表评价泪液荧光素清除的相关性和一致性。设计：病例对照研究。研究对象：健康人32例，酒渣鼻患者30例，非炎症性萎缩性泪囊炎患者24例，酒渣鼻患者39例。方法：每组受试者均完成症状问卷调查，进行荧光素清除试验、标准化视觉刻度试验、角膜荧光素染色、Schirmer 1试验、角膜结膜敏感度、眼睑缘及睑板腺检查。主要观察指标：L滴注5亩2%荧光素钠后15分钟，用细胞荧光分光光度计测下半月板微刺激性泪液中的荧光素浓度。在FCT泪液收集前，通过比较标准视力量表的颜色和外侧下半月板的颜色，得到SVST评分，范围为0~6。用症状问卷评估眼刺激的严重程度。进行Schirmer-1试验(无麻醉)、生物显微镜下的睑板腺评估和角膜荧光素染色。用Cochet-Bonnet感觉仪评估角膜和结膜敏感度评分。研究FCT、经Schirmer试验校正的FCT(校正FCT)、SVST和经Schirmer试验校正的SVST(校正SVST)在区分健康人和/或ATD、MGD患者时的相关性和一致性。结果：FCT、矫正FCT、SVST、矫正SVST与刺激性症状、角膜荧光素染色评分、角膜结膜敏感度、睑板腺及眼皮病变评分、角膜及结膜敏感度、眼睑病理特征均有较强相关性。FCT、校正FCT、SVST和校正SVST诊断MGD的敏感性分别为67%、72%、69%和76%，诊断ATD的敏感性分别为95%、97%、97%和97%。其特异度分别为97%、96%、97%和94%。结论：新的标准化视力量表在泪液清除率与刺激性症状、眼表和眼睑疾病、眼表敏感度的相关性方面与荧光法的评估结果相当。通过应用基于Schirmer测试分数的校正因子，它将健康人与MGD和ATD患者区分开来的能力得到了提高。新的标准化视力量表测试是临床评估荧光素泪液清除率的一种准确而实用的方法。(C)2000年由美国眼科学会授予。
Objective: To evaluate the correlation and the agreement between a validated fluorometric technique (fluorescein clearance test) and a newly developed, clinically practical standardized visual scale to evaluate tear fluorescein clearance. Also, the ability of this new method to distinguish healthy persons from patients reporting ocular irritation associated with meibomian gland disease (MGD), aqueous tear deficiency (ATD), or both was tested.Design: Case-controlled study.Participants: Healthy persons (n = 32), patients with MGD associated with rosacea (n = 30), patients with noninflammatory atrophic MGD (n = 24), and patients with ATD (n = 39) were evaluated. There was a similar age and gender distribution in each group.Methods: Each subject completed a symptom questionnaire and had the following tests performed: fluorescein clearance test (FCT), standardized visual scale test (SVST), corneal fluorescein staining, Schirmer 1 test, corneal and conjunctiva sensitivity, and eyelid margin and meibomian gland examination.Main Outcome Measures: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 mu l of 2% sodium fluorescein. The SVST score, ranging from 0 to 6, was obtained by comparing the colors of the standardized visual scale with the color of the lateral inferior tear meniscus immediately before tear collection for the FCT. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test (without anesthesia), biomicroscopic meibomian gland evaluation, and corneal fluorescein staining were performed. Corneal and conjunctival sensitivity scores were assessed with the Cochet-Bonnet aesthesiometer. The correlation and the agreement between FCT, FCT corrected for Schirmer test (corrected FCT), SVST, and SVST corrected for Schirmer test (corrected SVST) in separating healthy persons from patients with ATD, MGD, or both were studied. Furthermore, the correlations of FCT, corrected FCT, SVST and corrected SVST, corneal fluorescein staining score, corneal and conjunctiva sensitivity, meibomian gland and eyelid evaluation, and questionnaire score were studied.Results: The FCT, the corrected FCT, the SVST, and the corrected SVST all showed strong correlation with irritation symptoms, corneal fluorescein staining, Schirmer 1 test score, cornea and conjunctiva sensitivity, and meibomian gland and eyelid pathologic characteristics. The FCT, the corrected FCT, the SVST, and the corrected SVST had a sensitivity in diagnosing MGD, respectively, of 67%, 72%, 69%, and 76%, and of 95%, 97%, 97%, and 97% in diagnosing ATD. The specificity was, respectively, 97%, 96%, 97%, and 94%.Conclusions: The new standardized visual scale test was equivalent to fluorometric assessment of tear clearance in its correlation with irritation symptoms, ocular surface and eyelid disease, and ocular surface sensitivity. Its ability to separate healthy persons from patients with MGD and ATD was improved by applying a correction factor based on Schirmer test score. The new standardized visual scale test is an accurate and practical method for clinical assessment of fluorescein tear clearance. (C) 2000 by the American Academy of Ophthalmology.