眼部热敷贴联合睑板腺按摩与OPT治疗睑板腺功能障碍性干眼的临床疗效比较研究

Comparative study on the clinical efficacy of warm compress eye mask combined with meibomian gland massage and OPT in the treatment of dry eyes associated with meibomian gland dysfunction

目的比较眼部热敷贴联合睑板腺按摩与OPT治疗睑板腺功能障碍性干眼的临床疗效。方法这是一项随机、对照、非盲、单中心临床研究。选自上海和平眼科医院门诊就诊的30例患者,分为眼部热敷组10例(20只眼)、OPT组10例(20只眼)和对照组10例(20只眼)。三组基础治疗均为聚乙二醇滴眼液3次/天。眼部热敷组采用眼部热敷贴每周1次,共4次,每次20分钟,然后进行睑板腺按摩治疗。OPT组采用OPT治疗1次,然后进行睑板腺按摩治疗。对照组仅采用聚乙二醇滴眼液治疗。对三组患者治疗前、治疗4周后的眼表疾病指数(OSDI)、泪液分泌试验(SIT)、泪膜破裂时间(NITBUT)、泪河高度(NITMH)、睑板腺分泌功能(MGYSS)进行评估。结果其中热敷按摩组中男性4例,女性6例,平均年龄(63.80±6.44)岁,OPT组中男性4例,女性6例,平均年龄(58.10±7.09)岁,对照组中男性4例,女性6例,平均年龄(62.80±6.66)岁。三组治疗前,OSDI评分、SIT、NITBUT、NITMH、MGYSS评分的组间的比较,差异均无统计学意义(P>0.05)。三组治疗前、后OSDI、SIT、NITBUT、NITMH、MGYSS结果的差异均具有统计学意义(P<0.01)。治疗4周后,眼部热敷贴组及OPT组在OSDI评分上的均与对照组差异具有统计学意义(P<0.01);三组之间在SIT上的差异无统计学意义(P>0.05);眼部热敷贴组与对照组在NITBUT评分上的差异具有统计学意义(P<0.01),而OPT组与对照组的差异无统计学意义(P>0.05);眼部热敷贴组与OPT组在NITMH上的差异无统计学意义(P>0.05),与对照组的差异具有统计学意义(P<0.01);眼部热敷贴组与OPT组在MGYSS评分上均与对照组的差异具有统计学意义(P<0.01)。结论眼部热敷贴联合睑板腺按摩治疗拥有与OPT治疗相当的效果,均优于单纯人工泪液治疗。对于患者干眼的主观症状及泪膜质量的提高,睑板腺分泌功能的改善均具有一定的帮助。

Objective To compare the clinical efficacy of eye warm compress combined with meibomian gland massage and OPT in the treatment of meibomian gland dysfunction of dry eye.Methods This was a randomized,controlled,unblinded,single-center clinical study.A total of 30 patients from Shanghai Heping Eye Hospital were divided into three groups:warm compress group(n=10,20 eyes),OPT group(n=10,20 eyes)and control group(n=10,20 eyes).The basic treatment of the three groups was polyethylene glycol eye drops 3 times/day.In the warm compress group,the warm compress was applied once a week,4 times,20 minutes each time,and then meibomian gland massage treatment.OPT group was treated with OPT once and then meibomian gland massage.The control group was treated with polyethylene glycol eye drops only.The ocular surface disease index(OSDI),tear secretion test(SIT),tear film rupture time(NITBUT),lacrimal river height(NITMH)and meibomian gland secretory function(MGYSS)were evaluated before treatment and 4 weeks after treatment.Results There were 4 males and 6 females with an average age of(63.80±6.44)years in the warm massage group,4 males and 6 females with an average age of(58.10±7.09)years in the OPT group,and 4 males and 6 females with an average age of(62.80±6.66)years in the control group.Before treatment,there were no significant differences in OSDI score,SIT,NITBUT,NITMH and MGYSS score among the three groups(P>0.05).There were significant differences in OSDI score,SIT,NITBUT,NITMH and MGYSS score results between the three groups before and after treatment(P<0.01).After 4 weeks of treatment,the OSDI scores of the warm compress group and OPT group were significantly different from those of the control group(P<0.01).There was no significant difference in SIT among the three groups(P>0.05).The difference in NITBUT between the two groups was statistically significant(P<0.01),while there was no significant difference between the OPT group and the control group(P>0.05).There was no significant difference in NITMH between the two groups(P>0.05),but there was significant difference between the two groups(P<0.01).The MGYSS score of warm compress group and OPT group was significantly different from that of control group(P<0.01).Conclusion Warm compress combined with meibomian gland massage has the same effect as OPT treatment,which is superior to artificial tear therapy alone.It is helpful for the subjective symptoms of dry eye,the improvement of tear film quality and the improvement of meibomian gland secretion function.