原发性泪点狭窄的前节OCT特征及其与溢泪相关性的初步研究

Preliminary study on the correlation between primary lacrimal punctal stenosis and epiphora by using AS-OCT

摘要:

目的：应用眼前节光学相干断层扫描(AS-OCT)对原发性泪点狭窄患者的泪点进行量化，并分析其与溢泪的相关性。

方法：横断面研究。共纳入2020年9月至2021年1月于解放军总医院第三医学中心泪器病中心就诊的44例(62眼)原发性泪点狭窄伴溢泪的患者为观察组，对照组为43例(57眼)健康志愿者。对所有受试者的下泪点进行AS-OCT扫描，并对泪点图像进行量化，以观察其AS-OCT图像特征，测量参数包括泪点外径、泪点深度、泪点内残留泪液的液面直径及深度，根据以上参数计算泪点储备量及比率。

结果：1)符合正态分布的各测量参数用均数±标准差表示，结果如下，观察组：泪点外径458.19±63.58μm、泪点内残留泪液的直径200.34±84.69μm、泪点内残留泪液的深度188.95±87.50μm、泪点储备比率0.32±0.18； 正常对照组各测量参数为：泪点外径655.53±82.62μm、泪点内残留泪液的直径230.26±107.02μm、泪点内残留泪液的深度275.30±144.34μm、泪点储备比率0.46±0.23，观察组各参数均小于正常组(P<0.05)； 2)不符合正态分布的参数数据则用中位数及四分位数表示，结果如下，观察组：泪点深度265.50μm(四分位间距204.25-328.77)μm、泪点储备量71.53μm(四分位间距46.12-111.37)μm，对照组：泪点深度468.76 μm(四分位间距420.50-588.88)μm、泪点储备量182.16μm(四分位间距131.36-309.84)μm，观察组各参数数据均小于正常对照组(P<0.05)； 3)观察组测量数据显示，溢泪程度与泪点外径呈负相关(相关系数r=-0.448，P<0.05)、与泪点内残留泪液的深度呈正相关(相关系数r=0.335，P<0.05)、与泪点储备量及其比率呈负相关(相关系数r=-0.520、-0.566，P<0.05)。

结论：AS-OCT的使用可以帮助提高对泪点形态的认知； 泪点内残留泪液的深度以及泪点外径的大小与溢泪相关； 原发性泪点狭窄者中泪点储备泪液的潜在能力越强，溢泪程度越弱，且泪点外径小者相对于泪点外径大者更易出现溢泪症状。

Abstract:

AIM: To quantify the lacrimal punctum using anterior segment optical coherence tomography(AS-OCT)and analyze the correlation between the epiphora and primary punctal stenosis.

METHODS: A cross-sectional study. There were 43 healthy volunteers(57 eyes)and 44 patients(62 eyes)with primary lacrimal punctal stenosis and epiphora enrolled in the Lacrimal Center of the Third Medical Center of PLA General Hospital from September 2020 to January 2021. The inferior punctum of all subjects were scanned by AS-OCT, and the images were quantified in order to observe the AS-OCT image features. The outer punctal diameter, punctal depth, tear well diameter and tear well depth were all measured simultaneously. The inferior punctum's punctal reserve and punctal reserve ratio were estimated according to the available parameter data.

RESULTS: 1)The measured parameters conforming to normal distribution were expressed as mean±standard deviation. The observation group's outer punctal diameter, tear well diameter, tear well depth, and punctal reserve ratio were 458.19±63.58μm, 200.34±84.69μm, 188.95±87.50μm and 0.32±0.18, respectively, while the control group's outer punctal diameter, tear well diameter, tear well depth and punctal reserve ratio were 655.53±82.62μm, 230.26±107.02μm, 275.30±144.34μm, 0.46±0.23, respectively. The parameters in observation group were all lower than those of control group(P<0.05); 2)Parameter data that did not conform to normal distribution were expressed as medians and quartiles, and the results were as follows: the punctal depth in the observation group was 265.50μm(interquartile range 204.25-328.77)μm and the punctal reserve was 71.53μm(interquartile range 46.12-111.37)μm, respectively, while the punctal depth in the control group was 468.76μm(interquartile range 420.50-588.88)μm and the punctal reserve was 182.16μm(interquartile range 131.36-309.84)μm. This difference was statistically significant(P<0.05); 3)In the observation group, there was a negative correlation between the epiphora and the outer punctal diameter(r=-0.448, P<0.05), a positive correlation between the epiphora and tear well depth(r=0.335, P<0.05), and a negative correlation between the epiphora and the punctal reserve and punctal reserve ratio coefficient(r=-0.520, -0.566, P<0.05).

CONCLUSION: The AS-OCT can aid in enhancing punctal morphology cognition; The outer punctal diameter and tear well depth are related to the epiphora; The primary punctal stenosis patients with smaller outer punctal diameters are more likely to have the symptom of epiphora, and in patients with punctal stenosis, the greater the potential capacity of the punctum to hold tears, the lesser the degree of epiphora.