IPL联合睑板腺按摩治疗白内障围手术期MGD相关中重度干眼疗效分析  

Efficacy of intense pulsed light combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction in the cataract perioperative period

作　　者：杨珂[1] 朱蕾[1] 王滢珲 闻雅 接英[1] Yang Ke;Zhu Lei;Wang Yinghui;Wen Ya;Jie Ying(Beijing Tongren Eye Center,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]北京同仁眼科中心、北京市眼科学与视觉科学重点实验室、首都医科大学附属北京同仁医院,北京100730

出　　处：《中华实验眼科杂志》2023年第12期1195-1202,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金(82371022);青年北京学者计划项目(022)。

摘　　要：目的研究强脉冲光(IPL)联合睑板腺按摩治疗白内障患者围手术期睑板腺功能障碍(MGD)相关中重度干眼的疗效。方法采用非随机对照研究设计,纳入2020年10月至2021年12月就诊于首都医科大学附属北京同仁医院计划行双眼白内障摘除联合人工晶状体(IOL)植入术并患有MGD相关中重度干眼的患者40例40眼,采用Excel随机数公式随机选择一眼纳入研究。所有患者均常规使用人工泪液治疗干眼,不定期按需接受睑板腺按摩治疗,并依据患者意愿,根据是否接受IPL治疗,分为治疗组20例20眼和对照组20例20眼。治疗组手术前进行3次IPL治疗,每2次之间间隔2周,末次治疗完成至少2周后行白内障超声乳化吸除联合IOL植入术。2个组于首诊(基线)以及白内障术前1 d(即治疗组结束IPL治疗后2周)、术后1周以及术后1个月进行评估,包括眼表疾病指数(OSDI)评分、角膜荧光素染色情况、泪液分泌试验Ⅰ(SⅠt)、泪膜破裂时间(TBUT)、泪河高度、睑板腺萎缩不同评分眼数、睑板腺排出能力不同评分眼数。结果对照组基线、术前1 d、术后1周、术后1个月OSDI评分分别为(47.83±10.17)、(47.50±10.75)、(66.08±12.68)、(67.92±16.51)分,治疗组分别为(62.50±12.04)、(20.05±4.65)、(24.75±5.98)、(12.65±3.01)分,2个组不同时间点OSDI评分总体比较,差异均有统计学意义(F_(组别)=119.351,P<0.01;F_(时间)=86.219,P<0.01),其中治疗组术前1 d、术后1周和术后1个月OSDI评分均低于相应时间点对照组,基线OSDI评分高于对照组,差异均有统计学意义(均P<0.05);治疗组术前1 d OSDI评分较基线值显著降低,术后1周较术前1 d显著升高,但显著低于基线水平,术后1个月OSDI评分较术后1周再次显著降低,差异均有统计学意义(均P<0.05);对照组术后1周和术后1个月OSDI评分较术前1 d和基线值明显升高,差异均有统计学意义(均P<0.05)。治疗组术前1 d、术后1周和术后1个月角膜荧Objective To investigate the efficacy of intense pulsed light(IPL)combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction(MGD)in cataract patients during the perioperative period.Methods A non-randomized controlled study was conducted.Forty patients(40 eyes)with moderate to severe dry eye associated with MGD who planned to undergo binocular cataract extraction combined with intraocular lens(IOL)implantation at Beijing Tongren Hospital,Capital Medical University were enrolled from October 2020 to December 2021.One eye of each patient was randomly included using Excel RAND function.All patients received artificial tears regularly to treat dry eye symptoms,and meibomian gland expression was performed as needed.Patients were divided into a treatment group(20 patients,20 eyes)and a control group(20 patients,20 eyes)according to whether they wished to receive IPL therapy.The treatment group received IPL therapy 3 times before surgery,with a 2-week interval between each therapy,and phacoemulsification combined with IOL implantation at least 2 weeks after the last treatment.The two groups were evaluated at baseline,1 day before surgery(i.e.2 weeks after the last IPL treatment for the treatment group),1 week after surgery and 1 month after surgery.Outcome measures included Ocular Surface Disease Index(OSDI),corneal fluorescence staining,SchirmerⅠtest(SⅠt),tear break-up time(TBUT),meniscus height,the number of eyes with different scores of meibomian gland atrophy and the number of eyes with different scores of meibomian gland excretion capacity.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2017-063).Written informed consent was obtained from each subject.Results Baseline,1-day preoperative,1-week postoperative,1-month postoperative OSDI scores were(47.83±10.17),(47.50±10.75),(66.08±12.68),(67.92±16.51)points in control group,and(62.50

关 键 词：强脉冲光疗法 干眼 睑板腺功能障碍 白内障手术 疗效 

分 类 号：R779.6[医药卫生—眼科]