泪小管塞栓治疗重度慢性眼移植物抗宿主病的安全性和有效性  

Safety and efficacy of lacrimal canalicular plug in the treatment of severe chronic ocular graft-versus-host disease

作　　者：王贺 阴小月 张照委 王仡宁 张玲 赵颖奕 李明新 He Wang;Xiao-Yue Yin;Zhao-Wei Zhang;Yi-Ning Wang;Ling Zhang;Ying-Yi Zhao;Ming-Xin Li(Department of Ophthalmology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Graduate School,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院眼科,中国江苏省徐州市221000 [2]徐州医科大学研究生学院,中国江苏省徐州市221004

出　　处：《国际眼科杂志》2023年第7期1218-1224,共7页International Eye Science

基　　金：徐州市科技项目(No.KC20107);徐州医科大学附属医院发展基金资助项目(No.XYFY2021012)。

摘　　要：目的:评估泪小管塞栓治疗重度慢性眼移植物抗宿主病(coGVHD)的安全性和有效性。方法:回顾性研究。纳入2022-06/09就诊于徐州医科大学附属医院干眼门诊的重度coGVHD患者9例,均行双眼下泪小管塞栓术。观察术前、术后1、3mo眼表疾病指数(OSDI)评分、泪河高度(TMH)、角膜荧光素染色评分(CFS)、结膜丽丝胺绿染色评分(CLGS)、非接触式泪膜破裂时间(NIBUT)、SchirmerⅠ试验(SⅠt)和使用共聚焦角膜显微镜检测角膜浅基质层浸润的朗格汉斯细胞密度,记录并发症发生情况。结果:术后3mo,患者OSDI评分为21.89±6.07分,较术前(67.33±12.64分)下降(P<0.01);TMH术后3mo为0.21±0.03mm较术前0.09±0.02mm上升(P<0.05);NIBUT术后3mo为6.77±2.05s较术前2.24±0.68s上升(P<0.01)。CFS和CLGS术后3mo为2.22±0.67、2.56±0.88分较术前(9.11±1.45、6.33±1.00分)下降(均P<0.01)。朗格汉斯细胞密度术后3mo为39.67±9.75cells/mm~2较术前140.22±38.18cells/mm~2下降(P<0.01)。SⅠt手术前后无差异(F=0.059,P=0.943)。随访期间未观察到栓子脱落等并发症发生。结论:泪小管塞栓治疗重度coGVHD安全有效,可显著改善干眼患者症状体征,减轻炎症反应。AIM:To evaluate the safety and efficacy of lacrimal canalicular plug in the treatment of severe chronic ocular graft-versus-host disease (coGVHD).METHODS:Retrospective study.A total of 9 patients with severe coGVHD admitted to the dry eye clinic of the Affiliated Hospital of Xuzhou Medical University from June to September 2022 were included.All patients underwent binocular inferior lacrimal canaliculus plug.Ocular surface disease index (OSDI) score,tear meniscus height (TMH),corneal fluorescein staining (CFS) scores,conjunctival lisamine green staining (CLGS) score,noninvasive breakup time (NIBUT),Schirmer Ⅰ test (SⅠt) and the infiltration of Langerhans cells in the superficial corneal stroma tested by confocal corneal microscopy were observed before treatment and at 1 and 3 mo after treatment.At the same time,the complications related to lacrimal canalicular plug implantation were evaluated.RESULTS:The OSDI score decreased from 67.33±12.64 before treatment to 21.89±6.07 after 3mo of treatment ( P <0.01);TMH increased from 0.09±0.02mm to 0.21± 0.03mm after 3mo of treatment ( P <0.05),and NIBUT increased from 2.24±0.68s before treatment to 6.77±2.05s after 3mo of treatment ( P <0.01).In addition,the CFS and CLGS also changed significantly,from 9.11±1.45 and 6.33±1.00 before treatment to 2.22±0.67 and 2.56±0.88 at 3mo after treatment,respectively (all P <0.01).The density of Langerhans cells decreased from 140.22±38.18cells/mm 2 before treatment to 39.67±9.75cells/mm 2 3mo after treatment ( P <0.01).SⅠt showed no significant difference before and after treatment ( F =0.059,P =0.943).During the whole follow-up period,no complications such as plug abscission were observed.CONCLUSION:Lacrimal canalicular plug is safe and effective in the treatment of severe coGVHD.It can significantly improve the symptoms and signs of dry eye patients and reduce inflammatory reaction.

关 键 词：泪小管塞栓 移植物抗宿主病 干眼 

分 类 号：R779.6[医药卫生—眼科]