眼睑刷上皮病变治疗初步探讨

Clinical study of the treatment of lid-wiper epitheliopathy

目的通过观察不含防腐剂的人工泪液右旋糖酐70滴眼液治疗眼睑刷上皮病变(LWE)的效果,探讨LWE的治疗方法。方法选择2006年9月—2008年6月于北京大学第一医院眼科诊断为LWE的有干眼症状且常规干眼检查阴性的患者70例(70眼),分为治疗组54例(54眼)和对照组16例(16眼),治疗前后进行干眼症状问卷调查评分,行荧光素和丽丝胺绿双染色,观察LWE情况,根据病变范围和程度进行评分并分为轻、中、重度。结果治疗组患者采用右旋糖酐70滴眼液点眼2周,治疗前后症状评分分别为12.91±2.55和2.78±2.27,染色评分分别为1.79±0.78和0.19±0.31,治疗前后症状及染色差异均有统计学意义(t=22.70,Z=-6.40,P<0.05)。其中轻度15例、中度21例、重度18例,3组治疗前后染色评分差异均有统计学意义(Z轻=-3.47,Z中=-4.04,Z重=-3.74,P<0.05)。对照组患者观察2周,前后症状评分分别为12.63±2.60和12.94±2.11,染色评分分别为1.97±0.74和1.98±0.72,症状及染色差异均无统计学意义(t=-1.10,Z=-0.58,P>0.05)。结论人工泪液能有效地治疗LWE,缓解患者的干眼症状,是治疗LWE的有效方法。

Objective Current research proposed that lid-wiper epitheliopathy may be a early symptom of dry eye.At present,there are seldom studies on lid-wiper epitheliopathy in both home and abroad.This study was to investigate the effect of artificial tears without antiseptic in the treatment of lid-wiper epitheliopathy and discuss the method of treatment of lid-wiper epitheliopathy.MethodsThis is a case-observative study.Seventy patients with lid-wiper epitheliopathy and with negative results in tear film break-up test,SchirmerⅠtest and corneal fluorescine staining were enrolled in the Peking University First Hospital during September 2006 and June 2008.The treatment group included 54 eyes of 54 patients who received topically free-antiseptic artificial tears（dextran 70 eye drops）four times per day for two weeks,and the control group included 16 eyes from 16 patients who were not treated.Dry Eye Questionnaire were taken from the patients before the administration of drug and 2 weeks after treatment.Fluorescein and Lissamine green double-staining was used before and after treatment for the evaluation of lid-wiper epitheliopathy.The disease was graded into 0（absence）to 3（severe）,and the symptoms and dye were scored following the Standard Patient Evaluation of Eye Dryness（Korb criteria）.Informed consent and good compliance were obtained before initial and during the therapy duration.ResultsIn the treatment group,the scores of symproms and staining were significantly different between before and after administration of drug（12.91±2.55 vs 2.78±2.27 in symptom,t=22.70,P0.05;1.79±0.78 vs 0.19±0.31 in dye,Z=-6.40,P〈0.05）,indicating the symptoms and dye results were obviously improved after therapy.In the control group,no significant differences were found in the symptom score and dye score in the corresponding time period（12.63±2.60 vs 12.94±2.11,t=-1.10,P〉0.05 in symptom;1.97±0.74 vs 1.98±0.72,Z=-0.58,P〉0.05 in dye）.According to the grade of disease,the magnitude of the staining after treatment was considerably improved in comparison with before treatment（Z1=-3.47 for mild,Z2=-4.04 for moderate,Z3=-3.74 for severe）,showing statistically significant differences between them（P〈0.05）.ConclusionThe use of artificial tears is an efficacious treatment for treating lid wiper epitheliopathy.The topicaly utilization of artificial tears can alleviate the symptoms and pathological changes of lid wiper epitheliopathy.