角膜接触镜相关性干眼与睑板腺形态变化的关系

Relationship between contact lens-related dry eye and morphological changes of meibomian glands

目的探讨软性角膜接触镜(CL)长期配戴者睑板腺形态改变与干眼观察指标的关系。方法采用横断面研究方法,连续纳入2014年5月至2015年6月就诊于天津医科大学眼科医院拟行屈光性手术的患者157例314眼,其中长期配戴软性CL者91例182眼作为CL组,未配戴CL者66例132眼作为对照组。收集并比较2个组患者眼表疾病指数(OSDI)、泪河高度(TMH)、非侵入性首次泪膜破裂时间(fNITBUT)、平均泪膜破裂时间(avNITBUT)和角膜荧光素染色(CFS)评分情况;并进行睑板腺形态评估,包括睑板腺缺失率及腺体弯曲个数。结果CL组OSDI、CFS评分分别为16.67(10.00,25.00)和2.00(1.00,3.00),显著高于对照组的13.88(7.50,18.26)和1.00(0.00,2.00),差异均有统计学意义(U=9401.00、6969.50,均P<0.01);CL组TMH、fNIBUT和avNIBUT分别为0.20(0.17,0.23)mm、5.64(3.95,7.92)s和8.56(6.56,12.12)s,明显低于对照组的0.22(0.17,0.29)mm、7.33(4.54,13.21)s和11.49(7.46,17.83)s,差异均有统计学意义(U=9258.00、9047.00、8864.00,均P<0.01)。CL组患者的总睑板腺缺失率为(29.42±12.24)%,腺体弯曲个数为4(3,6),明显高于对照组的(20.37±10.83)%和3(1,4),差异均有统计学意义(t=6.76,P<0.01;U=7656.00,P<0.01)。CL组总睑板腺缺失率与配戴时间、OSDI评分、CFS评分均呈正相关(rS=0.404、0.275、0.319,均P<0.01)。结论长期配戴软性CL可导致较严重的眼部不适症状、干眼体征以及睑板腺形态的异常;长期配戴软性CL者出现眼部不适症状和干眼体征可能与其睑板腺异常有关。

Objective To explore the relationship between contact lens(CL)related dry eye and morphological changes of meibomian glands.Methods A cross-sectional study was performed.A total of 157 consecutive subjects(314 eyes)to underwent refractive surgery from May 2014 to June 2015 in Tianjin Medical University Eye Hospital were included.The subjects wearing soft CL for a long time were divided into CL group(182 eyes of 91 subjects),while the subjects who never wore CL were divided into the control group(132 eyes of 66 subjects).The ocular surface disease index(OSDI)questionnaire,tear meniscus height(TMH),first non-invasive tear film breakup time(fNIBUT),average non-invasive tear film breakup time(avNIBUT)and corneal fluorescein staining(CFS)score of all subjects were collected and analyzed.Morphological evaluation of meibomian glands were performed.The meibomian glands dropout ratio of upper eyelid,lower eyelid and total meibomian gland area as well as meibomian glands distortion number of the two groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Tianjin Medical University Eye Hospital(No.2014KY[L]-09).Written informed consent was obtained from each patients prior to any examination.Results The OSDI score,CFS score,TMH,fNIBUT and avNIBUT were 16.67(10.00,25.00),13.88(7.50,18.26),0.20(0.17,0.23)mm,5.64(3.95,7.92)s and 8.56(6.56,12.12)s in CL group,respectively,while 13.88(7.50,18.26),1.00(0.00,2.00),0.22(0.17,0.29)mm,7.33(4.54,13.21)s and 11.49(7.46,17.83)s in the control group,respectively.Compared with the control group,the CL group had the higher OSDI score,higher CFS score,lower TMH,lower fNIBUT,lower avNIBUT,and the differences were significant(all at P<0.01).The MG dropout ratio and meibomian gland distortion number were(29.42±12.24)%and 4(3,6)in CL group,respectively,while(20.37±10.83)%and 3(1,4)in the control group,respectively.In comparison with the control group,the CL group had the higher MG dropout ratio and greater meibomian gland distortion number(t=6.76,P<0.01;U=7656.00,P<0.01).A positive correlation was found between the total meibomian gland area dropout ratio and duration of CL wearing(rS=0.404,P<0.01),OSDI scores(rS=0.275,P<0.01),CFS scores(rS=0.319,P<0.01).Conclusions Long-term wearing of CL can lead to severe ocular discomfort,dry eye syndrome and morphological alterations in meibomian gland,suggesting that morphological abnormality of meibomian gland is presumably associated with the occurrence of ocular discomfort and dry eye syndromes in CL wearers.