过夜配戴角膜塑型镜对睑板腺与泪膜脂质层厚度的影响

Influence of overnight orthokeratology lens wearing on meibomian glands and tear film lipid layer

目的评价过夜配戴角膜塑型镜对睑板腺与泪膜脂质层厚度(LLT)的影响。方法选择过夜配戴角膜塑型镜1年以上的近视患者100例(100眼)作为过夜戴镜组,普通眼镜配戴者100例(100眼)作为未戴镜组,均使用Lipiview眼表面干涉仪测得LLT、眨眼频率以及不完全眨眼比率,Keratograph 5角膜地形综合分析仪测得红外线睑板腺图像、下泪河高度、非侵入式泪膜破裂时间(NI-BUT),计算上睑板腺缺失面积百分比,并测定泪液基础分泌量。比较两组上述各指标差异,并应用多元回归分析过夜戴镜组各参数与睑板腺缺失面积百分比及LLT之间的相关性。结果过夜戴镜组、未戴镜组的NI-BUT分别为7.83(5.27,14.09)s、5.68(4.03,13.01)s,过夜戴镜组NI-BUT更长(P<0.05)。过夜戴镜组、未戴镜组的上睑腺体缺失面积百分比分别为(14.38±7.09)%、(13.30±6.67)%,LLT分别为(57.97±18.59)nm、(56.61±20.67)nm,差异均无统计学意义(均P>0.05)。两组在泪液基础分泌量、下泪河高度、眨眼频率以及不完全眨眼比率等方面差异亦均无统计学意义(均P>0.05)。上睑板腺缺失面积百分比随下泪河高度的增加而减少,而LLT与NI-BUT呈正相关(P<0.05或0.01)。结论过夜配戴角膜塑型镜是相对安全的,在验配角膜塑型镜过程中,应关注睑板腺的基线状态。

Objective To evaluate the influence of overnight orthokeratology （OK） lens wearing on Meibomian glands and the tear film lipid layer.Methods One hundred myopic patients （100 eyes） wearing overnight OK lens for 〉1 year （overnight OK lens group） and another 100 myopic patients （100 eyes） wearing normal glasses （control group） were enrolled in the study.Tear-film lipid layer thickness （LLT）,blinking frequency and partial blinking were measured by the LipiView interferometer.The lower lid tear meniscus height,noninvasive tear break-up time （NI-BUT） and the structure of the Meibomian glands were assessed by Keratograph 5,the defect area percentage of Meibomian glands on the upper eyelid were calculated.The fundamental secretion of tears was measured.Covariance analysis,independent-samples T test,Mann-Whitney U tests,and multivariate regression were used in analyzing the data.Results The NI-BUT was 7.83（5.27,14.09） s and 5.68 （4.03,13.01） s in control group and the NI-BUT was significantly longer in the overnight OK lens group than that in control group （P〈0.05）.The defect area percentage of Meibomian glands on the upper eyelid was 14.38% ± 7.09% and 13.30% ± 6.67% in overnight OK lens group and control group,respectively（P〉0.05）.Tear-film lipid layer thickness was 57.97 ± 18.59 nm and 56.61 ± 20.67 nm in two groups,respectively（P〉0.05）.There were no statistical significances in fundamental secretion of tears,the lower lid tear meniscus height,blinking frequency and partial blinking between two groups （P 〉0.05）.The defect area percentage of Meibomian glands on the upper eyelid decreased as the lower lid tear meniscus height increasing and the lipid layer thickness of tear film had a positive correlation with NI-BUT.Conclusion The overnight OK lens wearing is relatively safe,and the baseline state of Meibomian gland should be taken into account in the prescription of orthokeratology lenses.