| Objective: Through the detection and comparison of different stages of diabetic retinopathy(diabetic retinopathy, DR) series of index patients and normal healthy people tear film, observation of the damage in patients with diabetic retinopathy the existence of tear secretion, tear film function and changes of corneal epithelium. Observe the relevant indexes is how to change, and each index and duration of diabetes, what is the correlation between DR stage. Causing the attention of physicians in the Department of Ophthalmology, patients with diabetic retinopathy, whether you need to regularly check the tear film function routine, and earlier diagnosis of the disease, reduce the misdiagnosis or missed diagnosis and prevent complications.Method:1 The object of study 2014 January to December in the choice of the outpatient department of ophthalmology in our hospital by the endocrine professional department confirmed the diagnosis of type 2 diabetes mellitus patients with a total of 80 cases(160 eyes), including male 43 cases, female 37 cases, age(62±8.702) years old. The control group for the same period in our hospital out-patient treatment in non diabetic patients, a total of 66 cases(132 eyes), including male 31 cases, female 35 cases, age(62.152±8.258) years old. All subjects underwent medical history, symptoms of dry eye inquiry and related inspection. 2 Self-conscious symptom A few main symptoms: dryness, foreign body sensation, eye fatigue, burning sensation and discomfort, visual acuity of fluctuation. 3 Inspection method Inspection is arranged in the same light to dark, quiet room, by trainedexperienced Department of Ophthalmology physician check operation 3.1 Schirmer I test( SIt) Schirmer I test reflected tear secretion. Inspection methods: Subjects back and sit on the light, with a cotton swab to suck out the conjunctival sac of residual liquid. With tear 5mm*30mm standard detection filter paper, since the gap opening reflexed foreign 5mm, 1/3 junction placement in lower eyelid conjunctiva sac, the other end let it have its swing droop, inform patients of light eyes closed. Time 5 minutes out filter strips, wetting length measurement. 3.2 Tear break-up time( BUT) BUT reflect the tear film stability. Inspection methods: the use of sodium fluorescein test, enjoin patient light blink several times, slit lamp cobalt blue light began to observe, from the last 1 times after blinking natural head up opened his eyes and started, until the corneal appear first spots in the calculation of time. A total of 3 measurements, average. 3.3 Corneal fluorescein staining(fluorescein, FL) Observation of the subjects of corneal epithelial staining of existence, if staining was positive, then the integrity of corneal epithelium damage. The use of fluorescein strip was observed under slit lamp, cobalt blue. The FL score is 12 points of law: the cornea was divided into 4 quadrants, each quadrant is 0 ~3, no staining was 0, 1 ~ 30 a punctate staining was recorded as 1 points, >30 a punctate staining staining, but no fusion of 2 points, the corneal punctate staining, silk and fusion ulcer is 3. 4 Diagnostic criteria: 4.1 Dry eye diagnosis standard: according to the 2013 ophthalmology branch of corneal disease study group of Chinese Medical Association[1] proposed at present our country dry eye diagnosis standard. 4.2 Diagnostic criteria for diabetes: Reference(WHO) 1999 criteria: not only have the typical symptoms of diabetes and include the following: 1 The amount of any one test, random blood glucose was more than 11.1mmol / L:2.Fasting plasma glucose was more than 7.0mmol / L:3. Impaired glucose tolerance(OGTT) inspection, load after 2 hours blood glucose was measured over 11.1mmol / L. 4.3 Criteria for the diagnosis of diabetic retinopathy, using a pre endoscopy fundus, fundus examination results according to clinical classification ", in reference to the international clinical classification of" diabetic retinopathy. 5 Data processing and analysis The obtained data was analyzed using SPSS16.0 statistical analysis software, using Student ’s t test, χ2 test, Wilcoxon rank sum test, set the P <0.05 when there is a statistically significant difference.Results:Between the DR group and the healthy control group of age and sex, no statistically difference. Two age groups compared with the t test, the P>0.05 between the two groups of gender; χ2 test was used to compare, P>0.05. There were no statistical differences. For statistical comparison. 1 DR group and the healthy control group, compared the incidence of dry eye DR group of dry eye prevalence rate was 57.5%, control group of dry eye prevalence rate was 18.2%,P<0.01,two groups has statistical significance, proof of diabetic retinopathy(DR)group of dry eye prevalence rate is higher than the control group. 2 DR group produces to the tear film function damage were comparedt 2.1 Schirmer I test SIt between two groups, DR group SIt was 10.987±6.217mm/5min, control group BUT was 15.610± 4.608mm/5min,t=-7.287,P<0.01,between the two groups have statistical significance,DR group decreased significantly compared with the control group, tear secretion. 2.2 BUT The results of BUT were compared between the two groups in diabetic retinopathy(DR) group BUT was 7.708±3.814 seconds, the control group BUT was 11.931±3.577 seconds, t=-9.744, P<0.01, between the two groups has statistical significance, tear break-up time was significantly reduced in DR group compared with the control group.3 DR group effect on corneal epithelium DR group of corneal fluorescein staining score than the control group increased significantly(Wilcoxon rank sum test,P<0.05),indicate that DR patients with corneal epithelial injury is more serious than the normal population. 4 The severity of DR and the relationship between tear film function damage 4.1 Schirmer I test At each stage of DR compared to SIt, F=4.481,P=0.013, between the three groups have statistical significance, two two compared with the LSD or SNK methods, show a significant difference between PDR group and NPDR lesion group, P <0.01. No other statistically significant. 4.2 BUT At each stage of DR compared to BUT,F=10.711,P=0.000, between the three groups have statistical significance, two two comparison, the PDR group and the other two groups(NPDR group, DR0 group) had significant difference,P<0.01, DR severity gradually increased, the BUT value is also shortened. 5 The relationship between the severity of DR and corneal epithelial damage At each stage of DR corneal FL tired integral comparison, nonparametric rank sum test,P<0.01, between the three groups have statistical significance. With the DR’s condition gradually worsened, corneal FL score increased significantly, there is significant correlation between the two.Conclusions:1 Patients with diabetes mellitus tear function changed to tear secretion decrease, the tear film instability, corneal epithelial injury, combined with DR in patients is particularly common and severe dry eye, high prevalence of diabetes in patients with PDR, especially dry eye of the common people. 2 There is a great correlation between the severity of the injury and the change of diabetic retinopathy, diabetic patients 2 ocular surface such as the cornea, conjunctiva, the tear film etc.. 3 In patients with diabetes, especially DR patients undergoing routineDepartment of Ophthalmology, consideration should be given to the possibility of ocular surface disease, suggestions for tear break-up time, Schirmer’s I test and corneal fluorescein staining and related inspection. 4 DR patients underwent laser photocoagulation, Department of ophthalmology operation treatment, should pay attention to prevent dry eye, corneal drug protection, produce to prevent serious complications. |
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