睑板腺功能障碍患者在FEMTO-LASIK术前行优化脉冲光治疗的前瞻性评价

Prospective evaluation of optimal pulse technology in patients with Meibomian gland dysfunction before FEMTO-LASIK

目的观察睑板腺功能障碍患者术前行优化脉冲光(OPT)治疗对飞秒辅助的准分子激光原位磨镶术(FEMTO-LASIK)术后眼表状态的影响。方法选取2017年6~7月来我院拟行FEMTO-LASIK手术并有轻、中度睑板腺功能障碍的患者28例(56只眼)。所有患者均行双眼FEMTO-LASIK手术,随机选取一眼为实验组,术前行OPT治疗联合睑板腺按摩,另一眼为对照组,不予OPT治疗,单纯予睑板腺按摩。术后1周、1个月分别完成睑缘形态评分、睑板腺脂质分泌、泪膜破裂时间、角膜上皮荧光素染色等检查。结果两组均无并发症发生。术后1周,睑缘形态、分泌物性状评分实验组和对照组有统计学差异,且实验眼评分低于对照眼。术后1个月,各项指标两组眼部评分有统计学差异,且实验眼评分低于对照眼。5项指标中除睑缘形态实验组和对照组相比有统计学差异(F=14.67,P<0.01)外,其他指标差异均无统计学意义。睑缘形态实验组不同时间点比较均有统计学意义(P<0.05)。结论 OPT联合睑板腺按摩较单纯睑板腺按摩更易使MGD患者睑脂排出,进而改善了睑板腺功能及泪膜的稳定状态。

Objective To evaluate the effects of optimal pulse technology（OPT） on the ocular surface and stability of tear films after femtosecond laser in-situ keratomileusis（ Femto-LASIK） in patients with Meibomian gland dysfunction（MGD）. Methods Twenty-eight patients（56 eyes） scheduled for Femto-LASIK with mild to moderate MGD were enrolled in June and July 2017. All patients underwent Femto-LASIK in both eyes. One eye was randomly chosen to receive OPT combined with Meibomian gland expression（ MGX） and the fellow eye was treated with MGX only. Changes in lid morphology score（ LMS）,secretions score（ SS）,gland expressbility（ GE）,tear break-up time（ BUT） and corneal fluorescein staining（ FLU） were observed at 1 week and 1 month after Femto-LASIK following baseline（ BL） evaluation. Results No serious adverse events were found. At 1 week after surgery,there was statistically significant difference between the groups in LMS,SS and GE,and scores were lower in the eye treated with both OPT and MGX. At 1 month,each index was significantly better in both eyes. Only LMS has statistically significant difference between OPT treated eyes and fellow eyes（ F = 14. 67,P〈0. 01）. LMS showed statistical difference from BL to 1 month after surgery in OPT treated eyes（ P〈0. 05）. Conclusions OPT combined with MGX was more effective than MGX alone to improve Meibomian gland function and tear film stability.