强脉冲激光治疗睑板腺功能障碍的临床观察

Clinical observation of intense pulsed light therapy for meibomian gland dysfunction

目的:研究强脉冲激光(intense pulsed light,IPL)对睑板腺功能障碍(eibomian gland dysfunction,MGD)的治疗效果,观察IPL是否改善MGD患者的症状。方法:回顾性非对照病例研究。选取2016-11/2017-02于武汉大学人民医院就诊的MGD患者21例42眼。检查方法:OSDI评分、角膜荧光素染色、泪膜破裂时间、眼表分析仪、共聚焦显微镜观察。所有患者每次IPL治疗间隔3wk,共行3次IPL治疗,1mo后门诊随访复查,采用配对样本t检验分析治疗前后结果差异。结果:治疗后,21例42眼患者OSDI评分降低,治疗前均值为30.18±4.07分,治疗后均值为24.87±4.32分;第一次泪膜破裂时间(first BUT)提高,治疗前均值为5.37±0.82s,治疗后均值为7.12±0.74s;平均泪膜破裂时间(mean BUT)提高,治疗前均值为7.73±1.14s,治疗后均值为11.37±2.23s;睑板腺分泌物评分降低,治疗前均值为1.57±0.52分,治疗后均值为1.22±0.52分;角膜荧光染色评分降低,治疗前均值为0.82±0.41分,治疗后均值为0.51±0.53分,差异均有统计学意义(t=11.2、2.68、3.31、2.78、2.61,P<0.05)。结论:IPL可以有效改善MGD患者主观症状,改善睑板腺阻塞,是MGD治疗的重要手段。

AIM： To investigate the effect of intense pulsed light on the meibomian gland dysfunction（MGD）, and to observe whether the intense pulsed light can improve the symptoms and objective indexes of the patients with meibomian gland dysfunction.METHODS： A retrospective noncomparative interventional case series was conducted. Totally 21 MGD patients（42 eyes）were selected from November 2016 to February 2017 in Renmin Hospital of Wuhan University, the results of the following tests is recorded： OSDI score, corneal fluorescein staining, tear break-up time, ocular surface analyzer, scanning confocal microscopy, all patients respectively were received intense pulsed light treatment 3 times at 3wk intervals, and followed up after 1mo. Paired sample t test was used to analyze the difference in outcome.RESULTS： In the 21 cases（42 eyes）, the OSDI score decreased, the mean value before treatment was 30.18±4.07, and the mean value after treatment was 24.87±4.32. The first tear film break-up time（first, BUT）increased, the mean value before treatment was 5.37±0.82s, the mean value after treatment was 7.12±0.74s. The mean value of meibomian gland secretion scores before the treatment was 1.57±0.52,the mean value after treatment was 1.22±0.52. The mean value of corneal fluorescence staining before treatment was 0.82±0.41, and the mean value after treatment was 0.51±0.53, the difference was statistically significant（t=11.2, 2.68, 3.31, 2.78, 2.61; P〈0.05）.CONCLUSION： Intense pulsed light can effectively improve the subjective symptoms of patients with MGD and alleviate the obstruction of meibomian glands. It is an important method for MGD treatment.