腺管探通术治疗睑板腺功能障碍的临床观察  

Clinical research on intraductal meibomian gland probing in the treatment of patients with meibomian gland dysfunction

作　　者：覃冬菊[1] 刘辉[1] 徐建江[2] 

机构地区：[1]上海市浦东医院眼科复旦大学附属浦东医院眼科,201399 [2]复旦大学附属眼耳鼻喉科医院眼科,上海200032

出　　处：《中华眼视光学与视觉科学杂志》2014年第10期615-621,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：上海市浦东新区卫生局资助项目（PW2011A-21）

摘　　要：目的 探讨睑板腺腺管探通术治疗睑板腺功能障碍（MGD）的临床疗效及安全性.方法 前瞻性配伍组设计.111例睑板腺功能障碍患者,按性别年龄相匹配分为3组,每组37人（37眼）,选择症状体征较重的眼作为观察眼.常规治疗组采用抗生素激素滴眼液＋人工泪液＋局部物理治疗;腺管探通术组在常规治疗组的治疗基础上用直径仅76 μm的不锈钢探针（美国Rhein Medical公司）,每只眼探通6～9个睑板腺腺管;腺管探通联合管内注药组在腺管探通组治疗基础上,探通术中管内注入适量妥布霉素地塞米松滴眼液.分别于治疗前和治疗后1个月观察MGD患者主观症状指标眼表疾病指数（OSDI）量表、泪膜破裂时间（BUT）、基础泪液分泌试验（SIT）检查、角膜荧光素染色（CFS）、裂隙灯显微镜下睑缘评分共5项指标的变化并做对比分析.对实施探通术2组的MGD患者分别于探通前及探通后1个月进行共聚焦显微镜检查,观察睑板腺腺泡单位有无损伤改变,以评价探通术的安全性.组内定量指标比较采用配对t检验,多组之间比较采用配伍组设计的两因素方差分析,差异有显著性后采用q检验进行两两比较.结果 ①3组MGD患者治疗前OSDI、BUT、CFS、SIT、裂隙灯下睑缘评分共5项观测指标基线值对比差异无统计学意义.②治疗后1个月3组之间5项检测指标差异有统计学意义（F=4.68、4.17、3.98、3.67、4.12,P＜0.05）;腺管探通术组与腺管探通联合管内注药组各项观测指标改善程度均优于常规治疗组,差异有统计学意义（P＜0.05）.腺管探通联合注药组经治疗后改善程度虽优于单纯探通术组,但差异无统计学意义.③实施探通术的2组MGD患者治疗后5项观测指标较治疗前均有显著改善,差异有统计学意义（腺管探通术组：t=2.543、2.343、2.456、2.132、2.237;腺管探通联合管内注药组：t=2.713、2.443、2.496、2.143、2.249,P均＜0.Objective To investigate the clinical efficacy and safety of intraductal meibomian gland probing in the treatment of patients with meibomian gland dysfunction （MGD）.Methods In a prospective randomized block design,111 consecutive patients （111 eyes） with MGD were divided into 3 groups.All subjects were age-and sex-matched among the 3 groups.The eye selected for the study in each subject was chosen on the basis of the most obvious symptoms.There were 37 eyes in each group.The conventional treatment group was treated only with antibiotic eye drops combined with topical steroids＋artificial tears＋local physical therapy; MGD patients in the intraductal probing group underwent intraductal probing with steel probes （Rhein Medical,Inc.USA） and 6～9 meibomian glands were probed in each eye; and the third group underwent intraductal probing combined with a drug （0.5％ tobramycin dexamethasone eye drops） injected into the intraductal meibomian gland during the probing procedure.All subjects underwent sequential examinations before and after treatment as follows：evaluation of ocular surface disease symptoms using the ocular surface disease index （OSDI）; tear film break-up time （BUT）; corneal fluorescein staining （CFS）; Schirmer I test （SIT）,and lid margin and ocular surface examination by slit lamp.The parameters among the 3 groups were investigated and compared before treatment and 1 month after treatment.Confocal microscope was performed to detect the safety of the intraductal meibomian gland probing by observing both the morphology and density of meibomian gland （MG） acinar units.The data among the three groups were randomly compared by a two-way ANOVA and q test （Newman-Keuls）; a paired t test was used to analyze the parameters in each group before treatment and 1 month after treatment.Results ①Before treatment,there were no statistical differences among the three groups in OSDI,BUT,CFS,SIT,or lid margin scores （P＞0.05）.②There were statistical differences among th

关 键 词：眼睑疾病 睑板腺 睑板腺功能障碍 显微镜检查 共焦 手术 

分 类 号：R779.6[医药卫生—眼科]