强脉冲光治疗对脂质异常型干眼睑板腺及泪膜脂质层的影响

Effects of intense pulsed light on the meibomian gland and tear film lipid layer in patients with lipid deficiency dry eye disease

目的观察强脉冲光(intense pulsed light,IPL)治疗对脂质异常型干眼患者睑板腺及泪膜脂质层的影响。方法采用随机数字的方法将60例(120眼)脂质异常型干眼患者分为对照组(60眼)及IPL组(60眼)。两组患者均于治疗前及治疗6周后使用非接触式泪膜破裂时间(non-invasive breakup time,NIBUT)、眼表疾病指数(ocular surface disease index,OSDI)问卷调查及角膜荧光素染色(corneal fluorescein staining,CFS)评估干眼相关指标;采用Oculus Keratograph眼表分析仪及睑板腺评估仪(meibomian gland evaluator,MGE)检测睑板腺缺失程度(meibomian gland dropout score,MGDS)、睑板腺排出能力(meibomian gland yielding liquid secretion,MGLYS)及睑酯性状(meibomian gland yielding secretion score,MGYSS)评估睑板腺相关指标;使用LipiView眼表面干涉仪评估泪膜脂质层厚度(lipid layer thickness,LLT)。结果两组患者基线特征差异无统计学意义。与治疗前相比,两组患者治疗后的NIBUT、OSDI、CFS、MGLYS、MGYSS及LLT均有不同程度的改善(P均<0.001),MGDS差异均无统计学意义。IPL组与对照组的MGDS差异无统计学意义,IPL组中其余指标改善均更明显(PNIBUT=0.031,POSDI=0.023,PCFS=0.014,PMGLYS=0.020,PMGLYS=0.023,PLLT=0.004)。治疗过程中,两组均未发生不良反应。结论IPL治疗能有效改善脂质异常型干眼患者的睑板腺功能、增加泪膜脂质层厚度。

Objective To observe the effects of intense pulsed light(IPL)on the meibomian gland and tear film lipid layer in patients with lipid deficiency dry eye disease.Methods A total of 60 patients(120 eyes)with lipid deficiency dry eye disease were divided into control group(60 eyes)and IPL group(60 eyes)using random numbers.Before and after 6 weeks of treatment,non-invasive breakup time(NIBUT),ocular surface disease index(OSDI)questionnaire,and corneal fluorescein staining(CFS)were assessed to evaluate the indicators of dry eye disease.The Oculus Keratograph analyzer and meibomian gland evaluator(MGE)were used to determine the meibomian gland dropout score(MGDS),meibomian gland yielding liquid secretion(MGLYS)and meibomian gland yielding secretion score(MGYSS)to assess the meibomian gland.The LipiView interferometer was used to evaluate the tear film lipid layer thickness(LLT).Results No statistically significant differences were observed between the two groups before treatment.Compared with baseline,NIBUT,OSDI,CFS,MGLYS,MGYSS and LLT were improved in both groups after treatment(all P<0.001),while there was no significant difference in MGDS.Except MGDS,the other parameters in the IPL group were improved better than those in control group after treatment(PNIBUT=0.031,POSDI=0.023,PCFS=0.014,PMGLYS=0.020,PMGLYS=0.023,PLLT=0.004).No adverse reactions occurred during the treatment.Conclusion IPL could improve the function of meibomian gland and the thickness of tear film lipid layer;it is an effective and safe treatment for patients with lipid deficiency dry eye disease.