EXTEND可吸收合成泪道塞治疗干眼的临床观察

Clinical evaluation of EXTEND absorbable synthetic implants for dry eyes

目的评价EXTEND可吸收合成泪道塞(EASI)治疗干眼的有效性、安全性及临床应用价值。方法对42例(42眼)轻中度水液缺乏性干眼(ATD)患者采用EASI进行泪道栓塞治疗。于治疗前、治疗后2周、1个月和3个月对患者行干眼症状的问卷调查,同时观察泪河高度(TMH)、泪膜破裂时间(BUT)、荧光素染色、丽丝胺绿染色和SchirmerⅠ试验(STⅠ),治疗前和3个月时行结膜印迹细胞学检查(IC)。结果EASI植入后2周、1个月和3个月时干眼症状评分分别为2.60±1.45、2.30±1.46和2.37±1.78,较治疗前(3.62±1.53)下降,差异有统计学意义(F=35.576,P<0.01)。治疗后满意率95.24%。治疗后人工泪液点眼平均次数(2.38±2.28)较治疗前(5.14±2.50)减少,差异有统计学意义(F=10.308,P<0.01)。EASI植入后,干眼患者泪河高度增加(F=36.371,P<0.01),BUT(F=24.83,P<0.01)和STⅠ(F=4.399,P=0.006)明显延长,角膜荧光素染色(F=12.088,P<0.01)和结膜丽丝胺绿染色(F=4.952,P=0.003)减轻。治疗后3个月时结膜上皮细胞鳞状化生现象有一定减轻。治疗期间未见严重并发症。结论EASI治疗ATD可明显减轻干眼症状,改善泪液的质和量,减少人工泪液点眼次数,是一种短期内治疗干眼安全有效的方法。

Objective Many types of punctual plugs have been developed recent year.This study was to evaluate the clinical efficacy of EXTEND Absorbable Synthetic Implants（EASI）during the treatment of dry eye.MethodsForty-two eyes from 42 patients with mild to moderate aqueous tear deficiency（ATD）dry eyes were chosen from Peking University First Hospital from March through September in 2007.Regular dry eye questionnaire was performed before treatment with EASI and 2 weeks,1 month and 3 months after treatment.Tear meniscus height（TMH）,tear break-up time（BUT）,Schirmer Ⅰtest（STⅠ）,fluorescein and lissamine green staining were carried out for the evaluation of dry eye.Impression cytology（IC）was utilized before treatment and 3 months after treatment.ResultsThe score of dry eye assessment at 2 weeks,1 month and 3 months after treatment was 2.60±1.45,2.30±1.46,and 2.37±1.78 respectively,and one before treatment was 3.62±1.53,showing a significant difference among them（F=35.576,P〈0.01）.These score was obviously improved after the application of EASI.95.24%patients（40/42）were satisfied with the management procedure.Compared with pretreatment,TMH was increased（F=36.371,P〈0.01）,and corneal fluorescein dye was reduced（F=12.088,P〈0.01）,and lissamine green staining（F=12.088,P〈0.01）,and TBUT（F=24.83,P〈0.01）and elongated scores of STⅠ（F=4.399,P=0.006）were increased.The usage times of artificial tears were less（2.38±2.28）than before（5.14±2.50）（F=10.308,P〈0.001）.The squamous metaplasia of conjunctival epithelial layer was improved at the 3 months.No serious adverse effect was found during the treatment.ConclusionThe application of EASI can relieve the symptoms of dry eye and improve tear volume and tear film stability.The treating approach with EXTEND Absorbable Synthetic Implants is safe and effective for ATD patients.