弹性软硅胶泪点塞治疗对重度干眼的短期疗效及对患者心理状况影响的研究  

The short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye patients

作　　者：阳雪[1] 李莹[1] Yang Xue;Li Ying. Department of Ophthalmology(Peking Union Medical College Hospital, Chinese Academy of Medical Sciences ＆ Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2018年第6期437-444,共8页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金面上项目（81170826）

摘　　要：目的评估弹性软硅胶泪点塞治疗重度干眼的短期临床疗效及其对患者心理状况的影响。方法自身前后对照研究。收集2017年1至9月就诊于北京协和医院眼科门诊的药物疗效不佳的重度干眼患者28例（56只眼），其中男性9例，女性19例，年龄（42．6±10．8）岁，给予弹性软硅胶泪点塞进行治疗。于治疗前及治疗后3个月观察患者裸眼视力、泪河高度、结膜评分、泪膜破裂时间、角膜荧光素染色评分、基础泪液分泌试验结果，并评估患者干眼体征变化情况，同时填写眼表疾病指数问卷、焦虑自评量表及流行病学调查用抑郁自评量表（cEs．D）以评估患者症状及心理状态的变化。正态分布的观察结果数据比较采用配对t检验，非正态分布的数据采用两配对样本的非参数检验，治疗前后症状及心理状况严重度比例变化采用趋势卡方检验，临床症状、体征及心理状态间相关性分析采用Spearman相关性分析。结果患者治疗前及治疗后3个月的眼表疾病指数评分分别为（65．77±21．28）、（42．85±20．08）分，裸眼视力（10gMAR）分别为0．10（0．30）、0．06（0．27），泪河高度分别为（0．17±0．09）、（0．35±0．17）mm，结膜评分分别为（2．96±1．13）、（1．57±0．99）分，泪膜破裂时间分别为（3．23±2．62）、（5．09±3．36）s，角膜荧光素染色评分分别为（7．32±4．46）、（5．15±4．02）分，基础泪液分泌试验分别为（4．09±3．48）、（8．15±5．96）mm，焦虑自评量表评分分别为（46．70±9．73）（40．59±8．98）分。以上指标与治疗前相比差异均有统计学意义（t=6．11，-6．31，8．91，-8．97，-3．83，5．06，-6．14，3．04；P〈O．01）。治疗前后流行病学调查用抑郁自评量表评分分别为（21．25±10．82）、（15．130±10．53）分，差异亦有统计学意义（t=2．38，P〈0．05）。治�Objective To evaluate the short-term efficacy and psycological influence of elastic silicon punetal plugs on severe dry eye patients. Methods Prospective case series study. Twenty-eight severe dry eye patients （56 eyes） treated with elastic silicon panctal plugs （Snug PlugsTM, FCI Ophthalmics, France） during January to September 2017 at the ophthalmology department of Peking Union Medical College Hospital were included. All the examination results were collected at baseline and 3 months after insertion. Uncorrected visual acuity （UCVA）, silt lamp examination, conjunctiva gradinz （CG）. lower tear meniscus height （TMS）, tear break-up time （BUT）, Sehirmer I test （S 1 t, without anesthesia）, corneal fluoresce staining （FS） were recorded to evaluate the efficacy of the plugs. Meanwhile, Ocular Surface Disease Index （OSDI）, Self-Rating Anxiety Scale （SAS） and Center for Epidemiological Survey-Depression Scale （CES-D） were collected to assess the changes of patients＇ symptoms and psychological status. Results At baseline and 3 months after punctal plugs insertion, mean OSDI score was 65.77±21.28 and 42.85±20.08; mean UCVA was 0.10 （0.30） and 0.06 （0.27）, mean TMS was （0.17±0.09） and （0.35±0.17） ram;mean CG score was 2.96±1.13 and 1.57±0.99; mean BUT was （3.23±2.62） and （5.09±3.36） s;mean FS seore was 7.32±4.46 and 5.15±4.02; mesn S I t was （4.09±3.48） and （8.15±5.96） mm; mean SAS score was 46.70±9.73 and 40.59±8.98, respectively. All the above differences between resuhs of baseline and 3 months after insertion were of statistical signifieance （t=6.11, -6.31, 8.91, -8.97, -3.83, 5.06, -6.14, 3.04, P〈0.01）. The mean CES-D score at baseline was 21.25±10.82, which was statistically different from the result of 15.00±10.53 at 3 months after insertion （t=2.38, P〈0.05）. The number and the severity of patients with anxiety or depression were reduced after insertion. OSDI score was negatively correlated with UCVA, TMH and S

关 键 词：干眼综合征 泪点塞 焦虑 抑郁 

分 类 号：R777.34[医药卫生—眼科]