睑板腺分析系统评估强脉冲光联合睑板腺按摩治疗睑板腺功能障碍相关干眼的有效性

doi:10.3760/cma.j.cn115909-20210228-00079

摘要
图/表
参考文献(16)
相关文章 (15)

全文: PDF 2851KB HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

文章导读

摘要

目的：观察应用睑板腺分析系统评估强脉冲光（IPL）联合睑板腺按摩治疗对睑板腺功能障碍（MGD）

相关干眼的有效性。方法：系列病例研究。选取2019 年7 ─8 月在西安市第四医院干眼门诊就诊的

MGD相关干眼患者37 例（74 眼），给予IPL联合睑板腺按摩治疗，每3 周治疗1 次，共3 次。通过重复

测量的方差分析评估患者治疗前、第1次治疗后、第2次治疗后和第3次治疗后眼表疾病指数（OSDI）、

非侵入泪膜破裂时间（NITBUT）、非侵入泪河高度（NITMH）、睑板腺分泌功能评分（MGYSS）、睑

板腺形变系数及显影值等指标的差异，采用Pearson线性相关分析探讨睑板腺形变系数和显影值与

眼表功能指标的相关性。结果：OSDI、NITBUT、MGYSS及睑板腺显影值在3 次治疗后均较治疗前

有明显改善，且差异均有统计学意义（P<0.001）。睑板腺形变系数在第1 次和第2 次治疗后，与治疗

前差异无统计学意义，而在第3 次治疗后，较治疗前改善，且差异有统计学意义（P=0.01）；NITMH

在3 次治疗后较治疗前无明显改善，差异均无统计学意义；从指标变化趋势上看，OSDI、NITBUT、

MGYSS及睑板腺显影值于第1 次治疗后持续好转，于第3 次治疗后疗效最佳，而睑板腺形变系数于

治疗后变化平缓，在3 次治疗后才有所提升。睑板腺形变系数与OSDI呈正相关（r=0.379，P=0.01），

与NITBUT呈负相关（r=-0.427，P=0.01），与NITMH（r=-0.132，P=0.538）和MGYSS无相关性；显

影值与OSDI呈负相关（r=-0.904，P<0.001），与NITBUT（r=0.947，P<0.001）和MGYSS呈正相关

（r=0.467，P<0.001），与NITMH无相关性。整个研究过程中未见不可逆的眼睑皮肤损伤，未见眼前

节炎性反应、虹膜脱色素、眼表或眼底损伤、视力下降及高眼压等并发症。结论：IPL联合睑板腺按

摩对MGD相关干眼的治疗有效、安全。睑板腺分析系统在一定程度上可反映腺体分泌能力，可通

过显影值等具体量化数据作为治疗效果评估的补充手段。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	戴鹏飞
	李颖
	王玉倩
	等

关键词 ：强脉冲光, 睑板腺按摩, 睑板腺功能障碍, 干眼, 睑板腺分析系统

Abstract：

Objective: To observe the therapeutic effects of intense pulsed light (IPL) combined with meibomian

gland massage on dry eyes associated with meibomian gland dysfunction (MGD) using the meibomiangland analysis system. Methods: This study was a case series study. A total of 37 outpatients (74 eyes)

with MGD-related dry eyes were selected from July 2019 to August 2019 at Xi'an Fourth Hospital.

Patients underwent IPL treatment combined with meibomian gland massage (once every three weeks,

three times in all). Intergroup comparisons of the ocular surface disease index (OSDI), non-invasive tear

film rupture time (NITBUT), non-invasive lacrimal river height measurement (NITMH), meibomian gland

yielding secretion score (MGYSS), deformation coefficient and photographic value of the meibomian

gland analysis system were performed before treatment and after the first, second, and third treatments. A

repeated measurement analysis of variance (ANOVA) was used for evaluation. Pearson linear correlation

analysis was used to assess the relationships between the deformation coefficient and the photographic

value of the meibomian gland and other variables of ocular surface function. The therapeutic effects of

IPL combined with meibomian gland massage on dry eyes associated with MGD were further evaluated.

Results: Indexes, including OSDI, NITBUT, MGYSS and photographic value, at each time point after

treatment were significantly improved compared with those before treatment, and the difference was

statistically significant (P<0.001). There was no significant difference in the deformation coefficient after

the first and second treatments, while the deformation coefficient significantly decreased after the third

treatment (P=0.01). NITMH data showed no significant improvement at each time point after treatment

compared with before treatment, and the difference was not statistically significant. As the trends for the

indicators changed, OSDI, NITBUT, MGYSS and photographic values continued to improve after the first

treatment, and were best after the third treatment. In addition, the deformation coefficient changed gently,

with a significant improvement only after the third treatment. The results showed that the deformation

coefficient of the meibomian gland was positively correlated with OSDI (r=0.379, P=0.01), negatively

correlated with NITBUT (r=-0.427, P=0.01), and had no correlation with NITMH and MGYSS. The

photographic value of the meibomian gland had a significant negative correlation with OSDI (r=-0.904,

P<0.001), a positive correlation with NITBUT (r=0.947, P<0.001) and MGYSS (r=0.467, P<0.001), and

had no correlation with NITMH. In the study, there was no irreversible eyelid skin injury, no anterior

segment inflammatory reaction, iris depigmentation, ocular surface or fundus injury, decreased vision,

high intraocular pressure or other complications. Conclusions: Both intense pulsed light combined with

palpebral gland massage are convenient, safe and effective for MGD-related dry eyes. The meibomian

gland analysis system can monitor the secretion capacity of glands to a certain extent, which can be used

as a supplementary means to evaluate the therapeutic effect through specific quantitative data such as the

photographic value.

Key words： intensive pulsed light meibomian gland massage meibomian gland dysfunction dry eyes the meibomian gland analysis system

收稿日期: 2021-02-28

PACS:

基金资助:西安市卫生健康委员会科研项目（2020yb14）

通讯作者: 李颖（ORCID：0000-0002-4384-6749），Email：liying1161@126.com

引用本文:

戴鹏飞，李颖，王玉倩，等. 睑板腺分析系统评估强脉冲光联合睑板腺按摩治疗睑板腺功能障碍相关干眼的有效性[J]. 中华眼视光学与视觉科学杂志, 2021, 23(12): 896-902. Pengfei Dai, Ying Li, Yuqian Wang,et al. The Efficacy of Intense Pulsed Light Combined with Meibomian Gland Massage in the Treatment of Meibomian Gland Dysfunction-Related Dry Eyes Using the Meibomian Gland Analysis System . Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(12): 896-902. DOI: 10.3760/cma.j.cn115909-20210228-00079

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210228-00079 或 https://www.cjoovs.com/CN/Y2021/V23/I12/896

[1]	亚洲干眼协会中国分会, 海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组. 我国睑板腺功能障碍诊断与治疗专家共识(2017年). 中华眼科杂志, 2017, 53(9): 657-661.DOI: 10.3760/cma.j.issn.0412-4081.2017.09.005.
[2]	余婷, 洪晶. 睑板腺功能障碍的治疗及其进展. 中华实验眼科杂志, 2018, 36(2): 150-155. DOI: 10.3760/cma.j.issn.2095-0160.2018.02.015.
[3]	Dell SJ. Intense pulsed light for evaporative dry eye disease.Clin Ophthalmol, 2017, 11: 1167-1173. DOI: 10.2147/OPTH.S139894.
[4]	Toyos R, McGill W, Briscoe D. Intense pulsed light treatmentfor dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg, 2015, 33(1):41-46. DOI: 10.1089/pho.2014.3819.
[5]	Vegunta S, Patel D, Shen JF. Combination therapy of intensepulsed light therapy and meibomian gland expression (IPL/MGX) can improve dry eye symptoms and meibomian gland function in patients with refractory dry eye: a retrospective analysis. Cornea, 2016, 35(3): 318-322. DOI: 10.1097/ico.0000000000000735.
[6]	亚洲干眼协会中国分会, 海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组, 中国医师协会眼科医师分会眼表与干眼学组. 中国干眼专家共识: 检查和诊断(2020 年).中华眼科杂志, 2020, 56(10): 741-747. DOI: 10.3760/cma.j.cn112142-20200714-00477.
[7]	Zheng B, Liu XJ, Sun YF, et al. Development and validationof the Chinese version of dry eye related quality of life scale.Health Qual Life Outcomes, 2017, 15(1): 145. DOI: 10.1186/s12955-017-0718-5.
[8]	Deng Y, Wang Q, Luo Z, et al. Quantitative analysis ofmorphological and functional features in Meibography for Meibomian Gland Dysfunction: Diagnosis and Grading.E Clinical Medicine, 2021, 40: 101132. DOI: 10.1016/j.eclinm.2021.101132.
[9]	Lane SS, DuBiner HB, Epstein RJ, et al. A new system,the LipiFlow, for the treatment of meibomian gland dysfunction. Cornea, 2012, 31(4): 396-404. DOI: 10.1097/ICO.0b013e318239aaea.
[10]	Campolmi P, Bonan P, Cannarozzo G, et al. Intense pulsedlight in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol, 2011,25(1): 68-73. DOI: 10.1111/j.1468-3083.2010.03700.x.
[11]	Craig JP, Chen YH, Turnbull PR. Prospective trial of intensepulsed light for the treatment of meibomian gland dysfunction.Invest Ophthalmol Vis Sci, 2015, 56(3): 1965-1970. DOI:10.1167/iovs.14-15764.
[12]	荣蓓, 涂平, 汤韵, 等. 强脉冲光联合睑板腺按摩治疗睑板腺功能障碍的短期疗效观察. 中华眼科杂志, 2017, 53(9): 675-681. DOI: 10.3760/cma.j.issn.0412-4081.2017.09.008.
[13]	Lacey N, Russell-Hallinan A, Zouboulis CC, et al. Demodexmites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea. Br J Dermatol, 2018, 179(2): 420-430.DOI: 10.1111/bjd.16540.
[14]	戴鹏飞, 李颖, 田芳, 等. 强脉冲光联合睑板腺按摩与眼睑熏蒸按摩治疗MGD相关干眼的疗效对比. 国际眼科杂志, 2019,19(12): 2101-2106. DOI: 10.3980/j.issn.1672-5123.2019.12.24.
[15]	Guilloto Caballero S, García Madrona JL, Colmenero Reina E.Effect of pulsed laser light in patients with dry eye syndrome.Arch Soc Esp Oftalmol, 2017, 92(11): 509-515. DOI: 10.1016/j.oftal.2016.12.018.
[16]	Dell SJ, Gaster RN, Barbarino SC, et al. Prospective evaluationof intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction. Clin Ophthalmol, 2017, 11: 817-827. DOI: 10.2147/OPTH.S130706.