氯替泼诺、氟米龙、环孢素在治疗睑板腺功能障碍性干眼的临床研究

Clinical Observation of Loteprednol,Fluorometholone,Cyclosporine or Combined with Carbomer in the Treatment of MeibomianGland Dysfunction Dry Eye Syndrome

目的观察氯替泼诺、氟米龙、环孢素在治疗睑板腺功能障碍性干眼(MGD)中的效果及安全性。方法将40例(80只眼)中MGD患者随机均分为4组,均以卡波姆眼液为基础用药,分别联合0.5%氯替泼诺眼液、0.1%氟米龙眼液、1%环孢素眼液,各组疗程均为8周。于治疗前及治疗4、8周后比较各组患者的主观症状、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、泪液分泌试验(SchirmerⅠ)和眼压(IOP)的变化,并观察不良反应发生情况。结果氯替泼诺组、氟米龙组,环孢素患者治疗后的BUT、FL评分均较治疗前显著改善(P<0.05),且优于对照组;各组患者治疗后的SchirmerⅠ结果和IOP均无显著变化。患者的干眼不适症状较用药前明显改善。但环孢素组患者眼部不适感高于其他组;氟米龙组患者发生2例IOP升高。结论氯替泼诺、氟米龙在MGD中效果明确,而氯替泼诺比氟米龙相对安全。环孢素疗效优于卡波姆,但患者耐受性差。

Objective To observe therapeutic efficacy and safety of loteprednol,fluorometholone,cyclosporine combined with carbomer in the treatment of meibomian gland dysfunction dry eye syndrome（MFD）.Methods40 patients （80 eyes）with MGD were randomly divided into 4 groups. Al groups were given 0.2%carbomer drops as routine treatment. 4 study groups were given 0.5%Loteprednol eye drops,0.1%Fluorometholone eye drops,1%Ciclosporin eye drops respectively. Treatment course of them lasted for 8 weeks. Finaly,dry eye syndrome score,breakup timeof lacrimal film（BUT）,corneal fluorescein staining （FL）,Schirmer test （SchirmerⅠ）,IOP and ADR were observed before and 4 and 8 weeks after treatment. ResultsCompared with before treatment,BUT and FL of combined with loteprednol group and fluorometholone group were improved significantly after treatment,and significantly better than those of control group and ciclosporin group（P〈0.05）. SchirmerⅠand IOP of those groups had no significant change after treatment. The patients dry eye syndrome were impoved after treatment.The incidence of smarting pain around eye and burning sensation in ciclosporin group were significantly higher than other 3 groups. Only two patients in fluorometholone group suffered from significant IOP increase. Conclusion Loteprednol or fluorometholone works quickly,can significantly improve the symptoms and shorten treatment duration;it is better than effect of other 2 schemes;loteprednol is safer than fluorometholone. Therapeutic efficacy of cyclosporine is better than that of carbomer alone,but shows poor tolerable.