使用LipiView眼表面干涉仪观察多次玻璃体腔药物注射对患者眼表泪膜稳定性的影响  

Effects of multiple intravitreal injection on the stability of ocular surface and tear film by LipiView eye surface interferometer

作　　者：丁海洋 王贺 李巧 郭建新 李明新 DING Haiyang;WANG He;LI Qiao;GUO Jianxin;LI Mingxin(Department of Ophthalmology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院眼科,江苏徐州221002

出　　处：《徐州医科大学学报》2021年第4期295-299,共5页Journal of Xuzhou Medical University

摘　　要：目的观察因新生血管性老年性黄斑变性(neovascular age-related macular degeneration,n AMD)行多次玻璃体腔抗血管内皮生长因子(VEGF)药物注射患者的干眼相关指标,探讨多次玻璃体腔注药对眼表泪膜稳定性的影响。方法本研究为一项前瞻性、随机、双盲、对照临床研究。选取2019年1月—3月于徐州医科大学附属医院眼科门诊就诊且需行玻璃体腔抗VEGF药物注射的n AMD患者,共50例。治疗前基线和每次治疗后第1天(共观察4次,分别以V0、V1、V2、V3表示)通过Lipi View眼表面干涉仪测量泪膜脂质层厚度(lipid layer thickness,LLT),睑板腺功能评分(meibomian gland yielding secretion score,MGYSS)、结合标准干眼症状评估(SPEED)问卷、泪膜破裂时间(tear breakup time,t BUT)、角膜荧光素染色和基础泪液分泌试验(SchirmerⅠ试验)结果,比较治疗眼和对照眼在不同时间点的干眼评价指标差异。结果 V0时与对照眼比较,治疗眼的LLT、MGYSS、SPEED评分、t BUT、角膜荧光素染色评分和SchirmerⅠ试验结果差异无统计学意义(P> 0.05)。随着注药次数的增加,与对照眼比较,治疗眼V1、V2、V3时LLT显著降低,V3时MGYSS显著降低,V2和V3时SPEED评分显著增加,V1、V2、V3时t BUT显著降低,V2和V3时角膜荧光素染色评分显著增加,与对照眼比较差异有统计学意义(P <0.01);治疗后各时间点治疗眼与对照眼的SchimerⅠ试验结果比较,差异无统计学意义(P> 0.05)。结论多次玻璃体腔药物注射可损害眼表微环境、导致泪膜稳定性下降,形成类似蒸发过强型干眼的临床改变。Objective To observe the related indexes about dry eyes in patients with neovascular age-related macular degeneration(nAMD)after multiple intravitreal anti-vascular endothelial growth factor(VEGF)injections,so as to explore its effects on the stability of ocular surface and tear film.Methods The current study was a prospective randomized,double-blind,controlled clinical study.A total of 50 nAMD patients who underwent multiple intravitreal injection of anti-VEGF agents in the Affiliated Hospital of Xuzhou Medical University from January to March 2019 were enrolled.The tear film lipid layer thickness(LLT)was measured by the LipiView ocular surface interferometer before treatment and on each day after treatment for three days(indicated as V0,V1,V2,and V3,respectively).Meanwhile,lipid layer thickness(LLT),meibomian gland yielding secretion score(MGYSS),SPEED dry eye questionnaire score,tear breakup time(tBUT),corneal fluorescein staining,and Schimer I test were used to compare the differences in dry eye evaluation indicators between treated and control eyes at each follow-up time.Results At V0,there was no statistical difference in LLT,MGYSS,SPEED score,tBUT,corneal fluorescein staining,and Schimer I test results between treated and control eyes(P>0.05).With the increases in injection,the treated eyes presented remarkable decreases in LLT at V1,V2 and V3,decreases in MGYSS at V3,increases in SPEED score at V2 and V3,decreases in tBUT at V1,V2 and V3,as well as increases in corneal fluorescein staining at V2 and V3,compared with the control eyes(P<0.01).There was no statistical difference as to Schimer I test results between the treated and control eyes at each time point after treatment(P>0.05).Conclusions Multiple intravitreal injections can damage ocular surface microenvironment,weaken tear film stability,and cause clinical changes similar to evaporative dry eyes.

关 键 词：玻璃体腔药物注射 干眼 老年性黄斑变性 脂质层厚度 

分 类 号：R772.2[医药卫生—眼科]