强脉冲光联合睑板腺按摩及地夸磷索钠滴眼液治疗脂质异常型干眼

Intense pulsed light combined with meibomian gland massage and diquafosol sodium eye drops in the treatment of lipid deficiency

目的:探讨强脉冲光联合睑板腺按摩及地夸磷索滴眼液治疗脂质异常型干眼的疗效及相关细胞因子的影响。方法:回顾性研究。选取2021-01/12在我院眼科门诊确诊为脂质异常型干眼患者511例1022眼为研究对象,根据患者治疗方式分为两组:研究组294例588眼采用地夸磷索钠滴眼液联合强脉冲光及睑板腺按摩治疗;对照组217例434眼采用人工泪液联合强脉冲光及睑板腺按摩治疗。检测治疗前后泪液中肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、乳铁蛋白(LF)水平。比较角膜荧光素染色(CFS)评分、泪膜破裂时间(BUT)、无表面麻醉下的基础泪液分泌试验(SⅠt)、眼表疾病指数(OSDI),分析治疗前泪液TNF-α、IL-1β、LF水平与CFS、BUT、SⅠt、OSDI相关性,观察不良反应的发生情况。结果:两组患者治疗前OSDI、SⅠt、BUT、CFS、泪液中TNF-α、IL-1β、LF水平比较无差异(P>0.05),治疗3、6、9wk研究组SⅠt、BUT、CFS、泪液中TNF-α、IL-1β、LF水平优于对照组(P<0.05)。治疗9wk后两组OSDI评分无差异(P>0.05)。泪液中TNF-α及IL-1β与SⅠt及BUT呈负相关,与CFS及OSDI呈正相关;LF与SⅠt及BUT呈正相关,与CFS及OSDI呈负相关(均P<0.01);研究组不良反应发生率5.78%显著低于对照组11.52%(P<0.05)。结论:强脉冲光联合睑板腺按摩及地夸磷索钠滴眼液治疗脂质异常型干眼疗效确切且耐受性好。

AIM:To explore the efficacy of intense pulsed light combined with meibomian gland massage and diquafosol eye drops in lipid deficiency dry eye disease and related cytokines.METHODS:A total of 511 patients(1022 eyes)with lipid deficiency dry eye diagnosed in the ophthalmology clinic of our hospital from January to December 2021 were selected as the research objects.They were divided into two groups according to the patient’s wishes:294 cases(588 eyes)in the study group were treated with diquafosol sodium eye drops combined with intense pulsed light and meibomian gland massage,while 217 cases(434 eyes)in the control group were treated with artificial tears combined with intense pulsed light and meibomian gland massage.The levels of tear tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and lactoferrin(LF)before and after treatment were detected,the corneal fluorescein staining(CFS)score,tear film break-up time(BUT),and SchirmerⅠ(SⅠt)under no surface anesthesia,ocular surface disease index(OSDI)were compared,the correlation between TNF-α,IL-1β,LF levels and CFS,BUT,SⅠt,OSDI before treatment was analyzed,and the occurrence of adverse reactions was observed.RESULTS:There was no significant difference in preoperative OSDI,SⅠt,BUT,CFS and levels of TNF-α,IL-1βand LF between the two groups(P>0.05).The SⅠt,BUT,CFS and levels of TNF-α,IL-1βand LF in the study group at 3,6 and 9wk after treatment were better than those of control group(P<0.05).There were no differences in OSDI score of both groups at 9wk after treatment(P>0.05).The TNF-αand IL-1βwere negatively correlated with SⅠt and BUT,while they were positively correlated with CFS and OSDI;LF and SⅠt were positively correlated with SⅠt and BUT,while they were negatively correlated with CFS and OSDI(all P<0.01);The adverse reaction rate of the study group(5.78%)was significantly lower than that of the control group(11.52%;P<0.05).CONCLUSION:Intense pulsed light combined with meibomian gland massage and diquafosol sodium eye drops is effective and well tolerated in the treatment of lipid deficiency dry eye.