泪点栓塞和人工泪液对干眼患者视功能和泪膜稳定性的影响

Effects of Lacrimal plugs and artificial tears on visual quality and tear film stability in xerophthalmia treatment

目的比较泪点栓塞和人工泪液对干眼患者视功能和泪膜稳定性的影响。方法选择2009年5月至10月于北京大学第三医院眼科就诊的干眼患者28例(56眼),随机分为人工泪液治疗组(16例)和泪点栓塞治疗组(12例),分别采用人工泪液和泪点栓塞进行治疗。分别于治疗前和治疗2周后针对干眼症状对患者进行问卷调查,并行角膜荧光素染色、泪膜破裂时间(break up time,BUT)、Schirmer I试验(Schirmer I test,SIT)和对比敏感度检查。结果问卷调查结果显示28例患者治疗前均有干眼相关的不适表现,经人工泪液或泪点栓塞治疗后症状均可改善,且两者效果差异无统计学意义(P=0.082)。角膜荧光素染色发现治疗前所有出现角膜荧光素着色的患者,经人工泪液或泪点栓塞治疗后荧光素染色均转为阴性。泪点栓塞组治疗前BUT为(3.1±1.5)s,治疗后为(6.6±1.3)s;人工泪液组治疗前BUT为(4.4±1.1)s,治疗后为(6.5±1.1)s;两组BUT值经治疗后均得到显著改善(P<0.001),且泪点栓塞组优于人工泪液组(P<0.001)。人工泪液组治疗前SIT值为(12.1±7.7)mm,治疗后为(14.4±9.0)mm,治疗前后无显著变化(P=0.072),而泪点栓塞组治疗前SIT值为(7.8±2.6)mm,治疗后为(14.0±3.4)mm,治疗前后SIT值有明显变化(P<0.001)。对比敏感度检查提示人工泪液组和泪点栓塞组均能显著提高干眼患者对比敏感度值,改善视觉质量,但两者的改善程度差异均无统计学意义(均为P>0.05)。结论人工泪液及泪点栓塞均可缓解干眼患者不适症状,修复角膜损伤,加强泪膜稳定性,提高对比敏感度,改善视觉质量,其中泪点栓塞较人工泪液能更好地维护泪膜稳定性,延长BUT。

Objective To compare the effects of lacrimal plugs and artificialtears on visual quality and tear film stability in patients with dry eye. Methods Twen- ty-eight patients with dry eyes treated at the center of ophthalmology of the 3rd hospi- tal, Peking University between May and October in 2009 were randomly divided into arti- ficial tears treatment group （ 16 cases） and lacrimal plugs treatment group （ 12 cases）. The two groups were treated with artificial tears and lacrimal plugs, respectively. Ques- tionnaires on dry eye symptoms were given to the patients and examinations of orneal fluorescein staining,break up time （BUT）, Schirmer I test （SIT） and contrast sensitivi- ty were carried out on the patients before treatment and after the treatment of 2 weeks. Results The results of the questiolmaires showed that 28 patients all had discomfort symptoms related with dry eyes before treatment,and the symptoms improved after the treatment with artifitial tears or lacrimal plugs, and no difference on effects between both was found statistically significant （ P = 0. 082 ）. Corneal fluorescein staining test displayed that patients with corneal fluorescein staining symptom before treatment all turned into negative in fluorescein staining after the treatment with artifitial tears or lac- rimal plugs. In lacrimal plugs group, BUT was （ 3.1 ± 1.5 ） s before the treatment, and was （6.6 ± 1. S ） s after the treatment; In artifitial tears treatment group, BUT was （4.4 ± 1.1 ） s before treatment and was （ 6. 5 ± 1. l ） s after treatment; BUT in both groups were significantly improved after treatment（P 〈 0.001 ） and lacrimal plugs treat- ment group was better than artifitial tears treatment group（P 〈0.001 ）. SIT was （ 12.1 ± 7.7） mm before treatment and was （ 14.4± 9.0） mm after treatment in artifitial tears treatment group, and no significant changes were found （ P = 0. 072 ） ; In lacrimal plugs treatment group,SIT was （7.8±2. 6）mm before treatment and was （ 14.0 ±3.4）ram af- ter treatment,and significant change was found （P 〈0.001 ）. The contrast sensitivity in- dicated that artifitial tears and lacrimal plugs could significantly improve the contrast sensitivity and visual quality in patients with dry eyes, but the differences on improve- ment had no statistical significance （ all P 〉 0.05 ）. Conclusion Artifitial tears and lacrimal plugs may relieve discomfort symptoms repair damaged cornea, strengthen tear film stability, improve contrast sensitivity and visual quality in patients with dry eyes. Lacrimal plugs may be better in protecting tear film stability and extending BUT.