传统治疗方法与应用睑板腺热脉动系统治疗睑板腺功能障碍的初步比较研究

A preliminary comparative study of the traditional treatment and thermodynamic treatment system for Meibomian gland dysfunction

目的评估睑板腺热脉动系统(LipiFlow)治疗睑板腺功能障碍(MGD)患者的疗效,并与传统热敷疗法的临床治疗效果比较。方法本研究为前瞻性、开放式、随机性的临床研究,将50例(100眼)MGD患者随机分为LipiFlow治疗组(25例50眼)和热敷治疗组(25例50眼)。LipiFlow治疗组给予1次12min的LipiFlow治疗;热敷治疗组给予热敷治疗,每次15min,每天治疗1次,连续2周。在治疗前及治疗后4、8、12周进行包括眼表疾病指数(OSDI)评分、泪膜脂质层厚度(LLT)、不完全眨眼频率(PB)、眼表荧光素染色、泪膜破裂时间(TBUT)、睑板腺开口数及睑板腺分泌物评分(MGYSS)等方面的临床评估,对2组患者的各项指标进行对比。结果2组患者的各项指标在治疗前差异均元统计学意义(P>0.05)。治疗后2组患者主观症状都有所缓解,LipiFlow治疗组的OSDI评分低于热敷治疗组(P<0.05);同时,LipiFlow治疗组LLT较治疗前有显著改善,而热敷治疗组LLT改善不明显,LipiFlow治疗组LLT较热敷治疗组有明显增加,差异具有统计学意义(P<0.05)。2组患者的眼表荧光素染色评分在治疗后均有所改善,LipiFlow治疗组的评分值较热敷治疗组更低(P<0.05)。在治疗后8、12周,LipiFlow治疗组的PB显著低于热敷治疗组,而TBUT值则显著高于热敷治疗组,差异均有统计学意义(P<0.05)。2组的睑板腺开口数及MGYSS评分在治疗4周后均获得改善,LipiFlow治疗组睑板腺开口数及MGYSS评分均显著高于热敷治疗组,差异具有统计学意义(P<0.01)。结论LipiFlow能有效改善MGD患者的不适症状及体征,其效果明显优于眼睑热敷治疗,且持续至少3个月。

Objective To evaluate the clinical efficacy of a thermodynamic treatment system (LipiFlow)for patients with Meibomian gland dysfunction (MGD),and to compare with traditional warm compress treatment.Methods This was a prospective,open and randomized clinical trial in which 50 subjects (100 eyes)with MGD were randomized to a LipiFlow group (n =50)and a traditional warm compress group (n =50).Subjects in the LipiFlow group received a 12 -minute LipiFlow treatment and the warm compress group received a 15-minute heat treatment with instructions to perform the same treatment dally for 2weeks.The following clinical parameters of the two groups were collected and compared before treatment and 4,8 and 12 weeks after the treatment:Ocular Surface Disease Index (OSDI),lipid layer thickness (LLT),partial blink ratio (PB),ocular surface fluorescein staining,tear break -up time (TBUT),the number of Meibomian gland orifices and Meibomian Gland Yielding Secretion Score (MGYSS).Results There were no significant differences in the indexes between the two groups before treatment (P >0.05).Mter the treatment,the subjective symptoms of both groups were relieved,and the OSDI scores of the LipiFlow group were significantly lower than those of the warm compress group (P <0.05).At the same time,the LLT of the LipiFlow group was significantly improved compared with that before treatment,while there was no obvious change in the warm compress group,and the score of the LipiFlow group was significantly lower than that of the warm compress group (P <0.05).The ocular surface fluorescein staining scores of both groups were improved after treatment.The reduction in the scores of the LipiFlow group was more obvious compared with the warm compress group after treatment (P <0.05).At 8 and 12 weeks after treatment,the PB of the LipiFlow group was significantly lower than that of warm compress group,while the TBUT value was significantly higher than that of the warm compress group (P <0.05).The number of Meibomian gland orifices and MGYSS scores in the two groups were improved after 4 weeks of treatment.The number of Meibomian gland orifices and MGYSS scores in the LipiFlow group was significantly higher than those in the warm compress group after treatment,the difference was statistically significant (P <0.01).The number of expressible Meibomian gland and the MGYSS of the two groups were improved at 4 weeks,which held at a higher level in the LipiFlow group while decreased at 8 weeks and basically recovered to the baseline level at 12 weeks in the warm compress group,the LipiFlow group resulted in significantly higher improvement than the warm compress group (P <0,01).Conclusions Meibomian gland heat pulse system can effectively improve the symptoms and signs of MGD patients,the effect is significantly better than traditional eyelid warm compress treatment,and.lasts for at least 3 months.