慢性泪囊炎合并睑板腺功能障碍综合治疗后疗效评价  

Efficacy evaluation of comprehensive treatment for chronic dacryocystitis with meibomian gland dysfunction

作　　者：张懿[1] 杨晓钊[1] 杨华[1] 郑璇[1] 卢海青 刘超[1] Zhang Yi;Yang Xiaozhao;Yang Hua;Zheng Xuan;Lu Haiqing;Liu Chao(Department of Ophthalmology,Xi'an No.1 Hospital,Shaanxi Institute of Ophthalmology,Shaanxi Key Laboratory of Ophthalmology,Clinical Research Center for Ophthalmology Diseases of Shaanxi Province,Department of Ophthalmology,First Affiliated Hospital of Northwest University,Xi’an 710002,Shaanxi Province,China)

机构地区：[1]中国陕西省西安市第一医院眼科/陕西省眼科研究所/陕西省眼科学重点实验室/陕西省眼科疾病临床医学研究中心/西北大学附属第一医院眼科,710002

出　　处：《国际眼科杂志》2024年第11期1836-1841,共6页International Eye Science

基　　金：陕西省重点研发计划项目(No.2024SF-YBXM-332);西安市科技计划项目(No.2019115913YX014SF047)。

摘　　要：目的:探讨慢性泪囊炎合并睑板腺功能障碍患者通过泪道激光成型并置管术及术后联合睑板腺治疗的疗效。方法:收集我院2021-03/2022-12慢性泪囊炎合并睑板腺功能障碍的患者128例,均行泪道激光成型联合置管术;术后随机分为2组,A组64例(无睑板腺治疗)、B组64例(睑板腺治疗),术后3 mo取出泪道置管后评价两组泪道冲洗通畅率;并对比两组眼表疾病指数(OSDI)评分、非侵袭性泪膜破裂时间、泪河高度、眼红分析、睑板腺分析、泪液脂质层厚度、泪液蕨类试验、结膜印记细胞检查的变化情况。结果:A组与B组泪道冲洗通畅率分别为78.1%、81.2%,两者比较无差异(P>0.05);与A组比较,术后3 mo B组患者非侵袭性泪膜破裂时间延长,OSDI评分、眼红分析、泪液蕨类试验及结膜印记细胞学分级降低(均P<0.05),而泪河高度、泪液脂质层厚度、睑板腺缺失评分两者无明显差异(均P>0.05)。结论:慢性泪囊炎合并睑板腺功能障碍患者综合治疗后其舒适度、泪膜稳定性、局部炎症反应有所好转,这类患者手术治疗的同时应同步重视眼表微环境异常的改善,以期达到满意的疗效。AIM:To investigate the efficacy of lacrimal duct laser dacryoplasty combined with intubation and postoperative meibomian gland treatment in patients with chronic dacryocystitis complicated by meibomian gland dysfunction.METHODS:Data were collected from 128 patients with chronic dacryocystitis complicated by meibomian gland dysfunction treated at Xi’an No.1 Hospital from March 2021 to December 2022.All patients underwent lacrimal duct laser dacryoplasty combined with intubation.Postoperatively,those patients were randomly divided into two groups:group A(64 cases,without meibomian gland treatment)and group B(64 cases,with meibomian gland treatment).The lacrimal intubation was removed at 3 mo after surgery to evaluate the patency rate of lacrimal irrigation.Additionally,changes in the ocular surface disease index(OSDI)score,non-invasive tear film break-up time,tear meniscus height,conjunctival hyperemia analysis,meibomian gland analysis,tear lipid layer thickness,tear ferning test,and conjunctival impression cytology were compared between the two groups.RESULTS:The lacrimal irrigation patency rates in the group A and group B were 78.1%and 81.2%respectively,with no statistically significant difference between the two groups(P>0.05);compared with the group A,group B showed a significant extension in non-invasive tear breakup time at 3 mo after surgery,and the OSDI score,conjunctival hyperemia analysis,tear ferning test and conjunctival impression cytology grading were all significantly decreased(all P<0.05),while there was no significant difference in tear meniscus height,tear lipid layer thickness and meibomian gland loss score between the two groups(all P>0.05).CONCLUSION:Comprehensive treatment for patients with chronic dacryocystitis combined with meibomian gland dysfunction have improved patients’comfort,tear film stability,and reduces local inflammatory response.It is important to simultaneously address ocular surface microenvironment abnormalities during surgical treatment to achieve satisfactory efficacy.

关 键 词：慢性泪囊炎 睑板腺功能障碍 眼表微环境 泪器病 

分 类 号：R777.1[医药卫生—眼科] R777.23[医药卫生—临床医学]