强脉冲光联合睑板腺按摩治疗睑板腺功能障碍

Evaluation of short-term effect of E-eye intense pulsed light combined with meibomian gland expression in the treatment of meibomian gland dysfunction

目的:比较强脉冲光(IPL)联合睑板腺按摩和单纯睑板腺按摩对睑板腺功能障碍(MGD)的短期疗效差异。方法:选取2019-10/2020-01在四川大学华西医院眼科就诊的MGD患者共40例80眼,随机分为试验组和对照组,两组均接受3次治疗,每次治疗中试验组双眼接受IPL联合睑板腺按摩,对照组双眼接受单纯睑板腺按摩,治疗时间间隔为2wk,整个试验期间两组均双眼应用玻璃酸钠每天4次,在每次治疗之前及最后一次治疗2wk后进行指标评估,从而评估IPL联合睑板腺按摩的短期疗效。结果:治疗后两组OSDI、SPEED评分均降低(P<0.05),两组间无差异(P>0.05)。两组睑板腺功能评估(MGE)、泪膜脂质层厚度(LLT)均升高,对照组升高较试验组慢,且第二、三次治疗后试验组MGE高于对照组(P<0.05)。两组泪膜破裂时间(BUT)均升高。两组角膜染色均下降,对照组下降较试验组慢,但两组间无差异(P>0.05)。两组视觉质量持续改善,但对照组改善较试验组慢,两组间无差异(P>0.05)。两组泪液分泌、不完全眨眼比例、睑板腺缺失率无明显变化(P>0.05)。所有受试者未出现皮肤、视力损害、眼压改变、眼前节炎症等并发症。结论:IPL联合睑板腺按摩与单纯睑板腺按摩对MGD均安全有效。IPL见效更快,效果可能有累积效应,在达到一定治疗次数后疗效更好。

AIM:To compare short-term effectiveness of E-eye IPL combined with meibomian gland expression to simple meibomian gland expression in the treatment of meibomian gland dysfunction(MGD).METHODS:Totally 40 patients with MGD(80 eyes)visiting the Department of Ophthalmology of West China Hospital of Sichuan University from October 2019 to January 2020 were randomly divided into experimental group and control group.Both eyes in the experimental group received IPL combined with meibomian gland expression,while those in the control group received meibomian gland expression only once every 2wk for 3 times.During the whole treatment,patients in the two groups received 0.3%sodium hyaluronate 4 times a day.Metrics were collected before each treatment and 2wk after the last treatment to evaluate the short-term efficacy of IPL combined with meibomian gland expression.RESULTS:OSDI and SPEED scores of the two groups decreased with statistical significance(P<0.05),but there was no statistical significance between the two groups(P>0.05).MGE and LLT of both groups increased.The increase in the control group was slower than that in the experimental group.MGE of the experimental group was higher than that of the control group after the second and third treatment,with statistical significance(P<0.05).BUT of both groups increased.Corneal staining in both groups decreased,and it decreased more in the experimental group than in the control group,with no statistical significance between the two groups(P>0.05).The visual quality in the two groups improved,but in improving visual quality the experimental group was much better than the control group(P>0.05).There was no significant change in tear secretion,incomplete blink ratio and meibomian gland loss rate in the two groups(P>0.05).There were no skin and visual impairment,intraocular pressure change,anterior segment inflammation and other complications in all subjects.CONCLUSION:IPL combined with meibomian gland expression and meibomian gland expression alone are both safe and effective.IPL,which has good,rapid effects and cumulative effects,works better after reaching a certain number of treatments.