配戴角膜接触镜对睑板腺影响的初步研究

The effect of long-term contact lens wear on the morphology of meibomian glands

目的 评价配戴角膜接触镜对睑板腺的影响,探讨定量分析法评价睑板腺缺失的价值.方法 回顾性分析2012年7月至2014年5月于北京大学第一医院就诊的角膜屈光手术患者60例,根据其角膜接触镜配戴史分为未配戴组（21例）、短期配戴组（配戴时长≤3年,19例）和长期配戴组（配戴时长＞3年,20例）.收集所有患者右眼的红外线睑板腺图像,使用睑板腺评分和软件定量分析评价睑板腺缺失情况.睑板腺评分采用例数（百分比）、睑板腺缺失面积百分比使用中位数（最小值,最大值）表示,采用单因素方差分析和Kruskal-Wallis检验比较组间的差异.结果 未配戴组（21例）中上睑评分0分10例,1分11例;总分0分7例,1分9例,2分5例.短期配戴（19例）组中上睑评分0分7例,1分10例,2分2例;总分0分5例,1分6例,2分6例,3分2例.长期配戴组中上睑评分0分4例,1分7例,2分9例;总分0分3例,1分4例,2分4例,3分4例,4分4例,5分1例.3个组上睑及总睑板腺评分的差异有统计学意义（Hc=9.967,P=0.007;Hc=9.725,P=0.008）,其中长期配戴组评分比未配戴组（Z=102.500,P=0.003;Z=100.500,P=0.003）和短期配戴组（Z=120.500,P=0.050;Z=117.500,P=0.041）高,而短期配戴组与未配戴组差异无统计学意义.未配戴组、短期配戴组及长期配戴组上睑腺体缺失面积百分比中位数依次为9.2％（0.0％,16.5％）、13.3％（0.0％,21.8％）、16.7％（0.0％,46.9％）;总腺体缺失面积百分比中位数依次为6.6％（0.0％,15.6％）、8.8％（0.0％,16.5％）、13.0％（0.0％,51.0％）.3个组上睑腺体缺失面积百分比及总腺体缺失面积百分比的差异均有统计学意义（Hc=6.390,P=0.041;Hc=7.019,P=0.030）,其中长期配戴组腺体缺失百分比较未配戴组高（Z=120.500,P=0.019;Z=120.500,P=0.009）,而短期配戴组与未配戴组及长期配戴组的差异无统计学意义.3个组下睑睑板腺评分和腺体缺失面积百分比的差异均无统计学意义.总腺体缺失面积百分比的ROC曲线下面积为0.981,且差异有统计学意义（P＜0.001）.结论 长时间（＞3年）配戴角膜接触镜可以造成睑板腺腺体缺失,定量分析法对评估腺体缺失情况有一定价值.

Objective To evaluate the effect of long-term contact lens （CL） wear on the morphology of meibomian glands （MGs） using meiboscore and digital analysis.Methods Retrospective study.Sixty right eyes of sixty patients were involved in this study,and the data were analyzed retrospectively.According to the duration of CL wear,all patients were divided into three groups,nonwear group （n=21）,short-term group （duration of CL wear ≤3 years,n=19） and long-term group （duration of CL wear〉3 years,n=20）.Digital images of MGs obtained by meibography were analyzed using Image.J software,providing the area percentage of MGs loss.The meiboscores were also examined,and the data were analyzed using one-way ANOVA and Kruskal-Wallis test.Results Ten out of 21 nonwearers were scored 0 point,and 11 were scored 1 point in the upper lid meiboscores,while 7 were scored 0 point,9 were scored 1 point,and 5 were scored 2 points in the total meiboscores.Seven out of 19 short-term wearers were scored 0 point,10 were scored 1 point,and 2 were scored 2 points in the upper lid meiboscores,while 5 were scored 0 point,6 were scored 1 point,6 were scored 2 points,and 2 were scored 3 points in the total meiboscores.Four out of 20 long-term wearers were scored 0 point,7 were scored 1 point,and 9 were scored 2 points in the upper lid meiboscores,while 3 were scored 0 point,4 were scored 1 point,4 were scored 2 points,4 were scored 3 points,4 were scored 4 points,and 1 was scored 5 points in the total meiboscores.The meiboscores of the upper eyelid and total meiboscores among the three groups were significantly different （Hc=9.967,P=0.007;Hc=9.725,P=0.008）.The meiboscores of the upper eyelid and total meiboscores were significantly higher in the long-term group compared to the nonwear group （Z=102.500,P=0.003,Z=100.500,P=0.003） and the short-term group （Z=120.500,P=0.050,Z=117.500,P=0.041）.No significant difference was found between the short-term group and the nonwear group.The median of the MGs loss area percentage in the upper eyelid of the nonwear,short-term and long-term groups was 9.2%,13.3% and 16.7%,respectively.The median of the total MGs loss area percentage in the nonwear,short-term and long-term groups were 6.6%,8.8% and 13.0%,respectively.The above medians were significantly different among the three groups （Hc=6.390,P=0.041;Hc=7.019,P=0.030）.They were significantly larger in the long-term wearers than the nonwearers （Z=120.500,P=0.019,Z=120.500,P=0.009）.No significant difference was found between the short-term group and the nonwear group,or between the short-term group and the long-term group.No significant differences in the meiboscores or MGs loss area percentage in the lower eyelid were noticed among the three groups.The area under the curve of total area percentage of MGs loss in receiver operating characteristic analysis was 0.981 （P〈0.001）.Conclusions Long-term （more than 3 years） CL wear can cause MGs loss.Digital analysis is helpful in the morphologic evaluation of MGs.