长期配戴角膜塑形镜对睑板腺功能和泪膜稳定性的影响

Changes of meibomian gland function and the stability of tear film after long-term wearing orthokeratolog

目的观察配戴角膜塑形镜岳睑板腺丢失率、睑板腺总积分、泪膜破裂时间（BUT）的变化，探讨长期配戴角膜塑形镜对睑板腺功能和泪膜稳定性的影响。方法采用前瞻性病例对照研究设计。纳入2013年10—12月在金水石迎辉眼科诊所就诊的近视患者50例98眼，根据患者近视矫正方式分为对照组（未配戴角膜塑形镜）24例47眼和试验组（配戴角膜塑形镜）26例51眼。观察并比较2个组患者戴镜前和戴镜3、6、24个月岳睑板腺丢失率、睑板腺总积分和BUT。结果试验组戴镜岳24个月的睑板腺总积分为4．54±1．10，比对照组的2．29±0．75显著增高，差异有统计学意义（P=0．000）；试验组戴镜岳24个月睑板腺总积分比戴镜前显著增高，差异有统计学意义（P〈0．05）。试验组戴镜前岳不同时间点的睑板腺丢失率与对照组比较，差异均无统计学意义（均P〉0．05）；试验组组内各个时间点的睑板腺丢失率两两比较差异均无统计学意义（均P〉0．05）。试验组戴镜岳6个月及24个月的BUT分别为（7．81±1．63）s和（6．35±1．52）s，比对照组的（9．46±2．13）s和（9．38±1．88）s显著缩短，差异均有统计学意义（P=0．003、0．000）；试验组戴镜岳BUT逐渐缩短，组内各个时间点问两两比较，差异有统计学意义（均P〈0．05）。结论长期配戴角膜塑形镜对睑板腺功能和泪膜稳定性均有影响，在戴镜3个月岳BUT缩短，睑板腺形态在戴镜岳24个月内未出现明显变化。

Objective This study was to observe the meibomian gland scores, the miss rate of meibomian, break-up time of tear film （BUT） changes after long-term wearing orthokeratolog, and to evaluate orthokeratolog impact on meibomian gland function and the stability of the tear film. Methods A prospective case-controlled study was performed. Fifty patients 98 eyes with myopia were enrolled. According to the myopia correction mode, the patients were divided into control group （24 cases） and experimental group （ overnight orthokeratolog treatment） group （26 cases）. All subjects were underwent the examinations sequentially as follows：evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index（OSDI） ,lid margin and ocular surface examination by slit lamp microscrope,infrared meibomian photography and BUT. All measurements were repeated at 3 months,6 months, 24-months follow-up visit. All patients signed informed consent before examination. Results After wearing orthok- contact lens for 24 months,the meibomian gland score was 4.54±1. 10 and 2.29±0.75 in the experimental group and control group, respectively, the difl＇erence was statistically significant （ P 〈 0.05 ）. The BUT was （ 6.35 ± 1.52 ） s 24 months after wearing orthokeratolog, which was less than （9.38 ± 1.88 ）s in the control group, the difference was statistically significant （P〈 0.05 ）. The miss rate of meibomian gland was 24.39 ± 5.54 and 22.81 ± 5.23 in the experimental group and control group,respectively. There was no statistically significant difrerence among the the miss rate of meibomian gland between groups and within groups （all at P〉0.05）. Conclusions Long-term wearing orthokeratolog has negetive effects on meibomian gland function and the stability of the tear film.