下泪小点烧灼治疗重度水液缺乏型干眼的临床疗效  

Effects of Inferior Lacrimal Punctum Cauterization for the Treatment of Severe Aqueous Tear-Deficient Dry Eye

作　　者：王静茹 陈水花 施文建[1] 高莹莹[1] Jingru Wang;Shuihua Chen;Wenjian Shi;Yingying Gao(Department of Ophthalmology,the Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院眼科,泉州362000

出　　处：《中华眼视光学与视觉科学杂志》2021年第10期773-780,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的: 评价高温烧灼封闭下泪小点治疗重度水液缺乏型干眼的临床疗效。方法: 前瞻性非随机对照研究。选择2019年6月至2020年10月在福建医科大学附属第二医院眼科就诊的使用人工泪液和局部抗炎保守治疗后疗效不佳的重度水液缺乏型干眼患者29例(58眼)。根据是否患有干燥综合征分为2组:干燥综合征干眼(SS)组17例(34眼)和非干燥综合征干眼(非SS)组12例(24眼)。采用高温热烧灼封闭双眼下泪点, 记录泪小点烧灼前2个月、1 d及烧灼后2周、2个月时患者的眼表疾病指数(OSDI)、泪膜破裂时间(TBUT)、角膜荧光素染色(FL)和泪液分泌试验(SⅠT)结果。数据分析采用独立样本t检验、配对样本t检验及单因素重复测量方差分析。结果: 2组烧灼前各项干眼相关指标差异无统计学意义。烧灼后2周和2个月与烧灼前1 d比较, SS组OSDI评分、TBUT及FL评分差异均有统计学意义(F=69.58, P<0.001;F=49.45, P<0.001;F=34.07, P<0.001);非SS组OSDI评分、BUT、FL评分及SⅠT值差异均有统计学意义(F=57.89, P<0.001;F=72.83, P<0.001;F=47.44, P<0.001;F=28.35;P<0.001), 但SS组SⅠT值差异无统计学意义。烧灼2个月后, 非SS组OSDI评分、TBUT、FL评分、SIT值均较SS组改善更明显(t=2.22, P=0.04;t=-3.32, P<0.001;t=2.90, P=0.01;t=-4.00, P<0.001)。SS组和非SS组均未发生明显眼部并发症, 最常见的并发症为泪道再通, 再通率为5.2%。结论: 下泪小点烧灼封闭治疗重度干眼可改善重度干眼的症状和体征, 是一种简单、经济且安全有效的方法, 对非干燥综合征干眼患者效果更佳。Objective:To evaluate the efficacy of inferior lacrimal punctum cauterization in the treatment of two types of severe aqueous deficient dry eyes.Methods:This was a prospective non-randomized controlled study.Twenty-nine severe aqueous tear-deficient dry eye patients(58 eyes)treated with artificial tears and topical anti-inflammatory conservation therapy from June 2019 to October 2020 at Department of Ophthalmology of the Secondary Affiliated Hospital of Fujian Medical University were enrolled.Patients were divided into two groups based on whether or not they had Sjögren's syndrome:Sjögren's syndrome dry eye(SS)group 17 cases(34 eyes)and non-Sjögren's syndrome dry eye(non-SS)group 12 cases(24 eyes).Cauterization of the inferior lacrimal punctum was performed on all participants.Data were collected at 2 months and 1 day before the operation,and 2 weeks and 2 months after the operation and included ocular surface disease index(OSDI),fluorescein breakup time(TBUT),corneal fluorescein staining(FL)and SchirmerⅠtest(SⅠT).Data was analyzed by an independent samples t test,paired samples t test and repeated measures one-way ANOVA.Results:There was no significant difference in any clinical indicators at baseline between the two groups.At 2 weeks and 2 months after the operation,OSDI score,TBUT and FL were significantly improved compared to 1 day before the operation in the SS group(F=69.58,P<0.001;F=49.45,P<0.001;F=34.07,P<0.001),and OSDI score,TBUT,FL and SⅠT were significantly improved compared to 1 day before operation in non-SS group(F=57.89,P<0.001:F=72.83,P<0.001;F=47.44,P<0.001;F=28.35;P<0.001).However,SⅠT was not significantly improved compared to 1 day before operation in the SS group.Two months after cauterization,all four indicators in the non-SS group improved more than those in the SS group(t=2.22,P=0.04:t=-3.32,P<0.001:t=2.90,P=0.01;t=-4.00,P<0.001).No adverse ocular effect was found in the study in two groups.The most common complication was the recanalization of the lacrimal passage.The recanaliz

关 键 词：高温烧灼 泪小点封闭 干燥综合征 干眼 

分 类 号：R777.34[医药卫生—眼科]