强脉冲光联合0.05%环孢素滴眼液治疗中重度睑板腺功能障碍相关干眼的临床效果观察  

Clinical observation of intense pulsed light combined with 0.05%cyclosporine eye drops in the treatment of moderate to severe meibomian gland dysfunction-related dry eye

作　　者：朱曼辉 赵庆亮 孙亚珂 王坤 王莹 Zhu Manhui;Zhao Qingliang;Sun Yake;Wang Kun;Wang Ying(Lixiang Eye Hospital of Soochow,Suzhou 215123,China;Department of Ophthalmology,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215000,China)

机构地区：[1]苏州理想眼科医院,苏州215123 [2]南京医科大学附属苏州医院眼科苏州市立医院,苏州215000

出　　处：《中华眼外伤职业眼病杂志》2024年第7期487-494,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家自然科学基金青年项目(No.82201219);苏州市姑苏卫生人才计划项目(No.(2022)192)。

摘　　要：目的评估强脉冲光联合0.05%环孢素滴眼液治疗中重度睑板腺功能障碍(MGD)相关干眼的临床效果。方法前瞻性随机对照研究。连续纳入2022年3月至2022年8月于苏州理想眼科医院就诊的经眼表综合分析仪检查睑板腺缺失比例达1/3以上的中重度MGD相关干眼60例(120只眼)。采用随机数字表法将研究对象分为3组,每组20例(40只眼):A组(玻璃酸钠滴眼液)、B组(玻璃酸钠滴眼液+强脉冲光)、C组(玻璃酸钠滴眼液+强脉冲光+0.05%环孢素滴眼液)。于治疗前、治疗后1个月、3个月进行眼表疾病指数量表(OSDI)评分,测定泪河高度(TMH)、非侵入性首次泪膜破裂时间(NIF-BUT)、眼红指数、泪膜脂质层厚度(LLT)、泪液分泌试验(SⅠt)、睑板腺分泌物排出能力和性状评分,并计算睑板腺丢失率,评估并比较3种疗法的有效性和安全性。结果随访期末,最终纳入A组17例(失访3例)、B组18例(失访2例)、C组17例(失访3例)患者。A组治疗后1和3个月眼红指数为1.97±0.46和1.88±0.54,较治疗前的2.21±0.81改善;治疗后3个月睑板腺分泌物排出能力评分为(2.17±0.39)分,较治疗前的(2.01±0.51)分增加(均P<0.05),其他指标治疗前后比较差异无统计学意义(均P>0.05)。B组治疗后1个月OSDI评分为(24.07±5.36)分、NIF-BUT为(4.87±0.92)s、眼红指数为2.03±0.38、LLT为(54.38±12.18)nm、睑板腺分泌物性状评分为(1.83±0.45)分,均优于治疗前的(37.27±7.35)分、(4.12±0.72)s、2.61±0.69、(49.91±13.84)nm、(2.24±0.37)分,且治疗后3个月改善更为明显,TMH及睑板腺分泌物排出能力评分在治疗后3个月分别为(0.21±0.04)nm及(2.11±0.33)分,优于治疗前的(0.19±0.05)nm及(2.24±0.37)分(均P<0.05),其他指标治疗前后比较差异无统计学意义(均P>0.05)。C组治疗后1个月,OSDI评分为(24.87±6.41)分、NIF-BUT为(4.84±1.01)s、TMH为(0.22±0.04)nm、眼红指数为2.09±0.29、LLT为(55.14±9.05)nm、睑板腺分泌物排出能力评分�Objective To evaluate the clinical efficacy of intense pulsed light(IPL)combined with 0.05%cyclosporine eye drops in the treatment of dry eye associated with moderate to severe meibomian gland dysfunction(MGD).Methods This was a prospective randomized controlled study.A total of 120 eyes of 60 cases with dry eye associated with moderate to severe MGD whose loss rate of the meibomian gland was more than 1/3 in Lixiang Eye Hospital of Soochow from Mar.2022 to Aug.2022 were selected as the research subjects.The patients were divided into three groups by means of random number table methods,with 20 cases(40 eyes)in each group:group A(sodium hyaluronate eye drops),group B(sodium hyaluronate eye drops+IPL),and group C(sodium hyaluronate eye drops+IPL+0.05%cyclosporine eye drops).Before treatment and at 1 month and 3 months after treatment,ocular surface disease index(OSDI)score,tear meniscus height(TMH),non-invasive first tear film break-up time(NIF-BUT),hyperemia index,tear film lipid layer thickness(LLT),Schirmer I test(SⅠt),meibomian gland morphology and function examination were measured,and the loss rate of meibomian gland was calculated to assess and compare the effectiveness and safety of the three therapies.Results At the end of the follow-up period,17 patients(3 cases missed)in group A,18 patients(2 cases missed)in group B,and 17 patients(3 cases missed)in group C were included.The results showed that the hyperemia index of group A at 1 and 3 months after treatment was 1.97±0.46 and 1.88±0.54,which improved compared to the 2.21±0.81 before treatment.The meibomian gland excretion score at 3 months after treatment was(2.17±0.39)points,which increased compared to the(2.01±0.51)points before treatment(all P<0.05).There was no statistically significant difference in other indicators(all P>0.05).At one month after treatment,the OSDI score of group B[(24.07±5.36)points],NIF-BUT[(4.87±0.92)s],hyperemia index(2.03±0.38),LLT[(54.38±12.18)nm],and meibomian gland secretion score[(1.83±0.45)points]were better t

关 键 词：干眼综合征 环孢菌素 睑板腺功能障碍 强脉冲光 

分 类 号：R777.13[医药卫生—眼科] R777.34[医药卫生—临床医学]