AIM:To investigate the efficacy and mechanisms of indirect intense pulsed light(IPL)irradiation on meibomian gland dysfunction(MGD).METHODS:A total of 60 MGD patients was included in this prospective randomized contro...AIM:To investigate the efficacy and mechanisms of indirect intense pulsed light(IPL)irradiation on meibomian gland dysfunction(MGD).METHODS:A total of 60 MGD patients was included in this prospective randomized controlled trial.Patients were randomly assigned 1:1 into two groups(3-mm group and 10-mm group)in which IPL was applied at distances from the lower eyelid margin of 3 and 10 mm,respectively.Both groups received three times treatment with 3-week interval.Meibomian gland yield secretion score(MGYSS),standard patient evaluation of eye dryness(SPEED)questionnaire,tear break-up time(TBUT),corneal fluorescein staining(CFS),and in vivo confocal microscopy were performed at baseline and after every treatment.RESULTS:After three IPL treatments,both groups had significant improvement in MGYSS(both P<0.05).The noninferiority test showed that improvement in 10-mm group was not inferior to that in 3-mm group(P<0.001).In both groups,temporal regions of both upper and lower eyelids showed significant improvement in MGYSS.Scores of SPEED questionnaire in both groups declined significantly(both P<0.001)and changes of SPEED had no difference between two groups(P=0.57).Density of central corneal subepithelial nerves and TBUTs showed no statistically significant changes.The 3-mm group had improvement on corneal fluorescein staining(P=0.048)and meibomian gland morphology(acini wall thickness P=0.003,hyperreflective points P=0.024)while the 10-mm group had not.CONCLUSION:The efficacy of IPL indirect irradiation in improving meibomian gland secretion and alleviating dry eye symptoms remains unchanged with increase in treatment distance.IPL may primarily act on the functional improvement of the meibomian glands and corneal nerves.展开更多
The meibomian gland is a unique sebaceous gland located in the eyelid.Its main function is to secrete lipids and form the lipid layer of the tear film to delay the evaporation of waterborne tears,increase the surface ...The meibomian gland is a unique sebaceous gland located in the eyelid.Its main function is to secrete lipids and form the lipid layer of the tear film to delay the evaporation of waterborne tears,increase the surface tension of the tear film,and to lubricate the contact area of the eyelid and eyeball.Abnormal secretion of the meibomian gland is known as meibomian gland dysfunction(MGD),which has become the most important cause of evaporative dry eye disease(DED).The clinical pathophysiological process and underlying molecular mechanisms of MGD are not clear.As serious side effects may occur with the long-term use of hormonotherapy and non-steroidal anti-inflammatory drugs(NSAIDs)for the treatment of MGD,meibomian gland physiotherapy is considered the most effective and safest therapy for MGD.This review summarizes the physical therapy modalities of western medicine(WM)and traditiond Chinese medicine(TCM)for the treatment of MGD to provide optimal treatments for these patients and to further lay a foundation for mechanistic studies of MGD.展开更多
目的通过对睑板腺功能障碍(meibomian glands dysfunction,MGD)患者的规范化物理治疗,分析规范化物理治疗对MGD的治疗效果。方法选取2018年9月至2019年5月就诊于延安市人民医院眼科的MGD性干眼患者80例。患病时间为0.5~3年。随机分为治...目的通过对睑板腺功能障碍(meibomian glands dysfunction,MGD)患者的规范化物理治疗,分析规范化物理治疗对MGD的治疗效果。方法选取2018年9月至2019年5月就诊于延安市人民医院眼科的MGD性干眼患者80例。患病时间为0.5~3年。随机分为治疗组与对照组,治疗组43例,对照组37例。治疗组为规范化物理治疗+药物治疗,对照组为传统物理治疗+药物治疗。治疗1月后,分析2组的治疗效果。结果治疗组有效率为95.35%,对照组有效率为56.76%,2组间比较差异有统计学意义;同时观察2组患者治疗前后的睑酯排出能力、睑酯性状及泪膜破裂时间(break-up time of tear film,BUT),发现2组患者治疗前后的睑酯排出能力评分、睑酯性状评分、BUT时间比较差异有统计学意义。结论规范化物理治疗MGD能够有效排出堆积的睑板腺异常睑酯,减轻局部炎症反应,缓解患者的干眼症状,该治疗成本低,疗效佳,易推广。展开更多
The tear film covers the anterior eye and the precise balance of its various constituting components is critical for maintaining ocular health.The composition of the tear film amphiphilic lipid sublayer,in particular,...The tear film covers the anterior eye and the precise balance of its various constituting components is critical for maintaining ocular health.The composition of the tear film amphiphilic lipid sublayer,in particular,has largely remained a matter of contention.The limiting concentrations of lipid amphiphiles in tears have also posed considerable challenges to their detection and accurate quantitation.Using systematic and sensitive lipidomic approaches,we reported the most comprehensive human tear lipidome to date;and conferred novel insights to the compositional details of the existent tear film model,in particular the disputable amphiphilic lipid sublayer constituents,by demonstrating the presence of cholesteryl sulfate,O-acyl-ω-hydroxy fatty acids,and various sphingolipids and phospholipids in tears.Lipidomic analysis of human tear fluid from patients with various subtypes of dry eye syndrome(DES)revealed structure-specific lipid alterations in DES,which could potentially serve as unifying indicators of disease symptoms and signs.The meibomian glands constitute the predominant source of lipid supply to the human tear fluid.Meibomian gland dysfunction(MGD)is a leading cause of evaporative dry eye and ocular discomfort,characterized by an unstable tear film principally attributed to afflicted delivery of lipids to the ocular surface.We investigated the longitudinal tear lipid alterations associated with disease alleviation and symptom improvement in a cohort of MGD patients undergoing eyelid-warming treatment for 12 weeks.Our preliminary data indicated that excess ocular surface phospholipase activity detrimental to tear film stability could be alleviated by eyelid warming alone without application of steroids and identify tear OAHFAs as suitable markers to monitor treatment response in MGD.展开更多
基金Supported by the National Natural Science Foundation of China(No.81870629).
文摘AIM:To investigate the efficacy and mechanisms of indirect intense pulsed light(IPL)irradiation on meibomian gland dysfunction(MGD).METHODS:A total of 60 MGD patients was included in this prospective randomized controlled trial.Patients were randomly assigned 1:1 into two groups(3-mm group and 10-mm group)in which IPL was applied at distances from the lower eyelid margin of 3 and 10 mm,respectively.Both groups received three times treatment with 3-week interval.Meibomian gland yield secretion score(MGYSS),standard patient evaluation of eye dryness(SPEED)questionnaire,tear break-up time(TBUT),corneal fluorescein staining(CFS),and in vivo confocal microscopy were performed at baseline and after every treatment.RESULTS:After three IPL treatments,both groups had significant improvement in MGYSS(both P<0.05).The noninferiority test showed that improvement in 10-mm group was not inferior to that in 3-mm group(P<0.001).In both groups,temporal regions of both upper and lower eyelids showed significant improvement in MGYSS.Scores of SPEED questionnaire in both groups declined significantly(both P<0.001)and changes of SPEED had no difference between two groups(P=0.57).Density of central corneal subepithelial nerves and TBUTs showed no statistically significant changes.The 3-mm group had improvement on corneal fluorescein staining(P=0.048)and meibomian gland morphology(acini wall thickness P=0.003,hyperreflective points P=0.024)while the 10-mm group had not.CONCLUSION:The efficacy of IPL indirect irradiation in improving meibomian gland secretion and alleviating dry eye symptoms remains unchanged with increase in treatment distance.IPL may primarily act on the functional improvement of the meibomian glands and corneal nerves.
基金We thank for the funding support from the Research and Innovation Project of Graduate Students in Hunan Province(No.CX20190538)the First-class Open Fund for Integrated Chinese and Western Medicine(No.2018ZXYJH05)+1 种基金the Traditional Chinese Medicine First-Class Discipline Open Fund(No.2018ZYX57)the Construction Project of Hunan Engineering Technology Research Center for the Prevention and Treatment of Otorhinolaryngologic Diseases and Protection of Visual Function with Chinese Medicine(No.2018YGC02).
文摘The meibomian gland is a unique sebaceous gland located in the eyelid.Its main function is to secrete lipids and form the lipid layer of the tear film to delay the evaporation of waterborne tears,increase the surface tension of the tear film,and to lubricate the contact area of the eyelid and eyeball.Abnormal secretion of the meibomian gland is known as meibomian gland dysfunction(MGD),which has become the most important cause of evaporative dry eye disease(DED).The clinical pathophysiological process and underlying molecular mechanisms of MGD are not clear.As serious side effects may occur with the long-term use of hormonotherapy and non-steroidal anti-inflammatory drugs(NSAIDs)for the treatment of MGD,meibomian gland physiotherapy is considered the most effective and safest therapy for MGD.This review summarizes the physical therapy modalities of western medicine(WM)and traditiond Chinese medicine(TCM)for the treatment of MGD to provide optimal treatments for these patients and to further lay a foundation for mechanistic studies of MGD.
文摘目的通过对睑板腺功能障碍(meibomian glands dysfunction,MGD)患者的规范化物理治疗,分析规范化物理治疗对MGD的治疗效果。方法选取2018年9月至2019年5月就诊于延安市人民医院眼科的MGD性干眼患者80例。患病时间为0.5~3年。随机分为治疗组与对照组,治疗组43例,对照组37例。治疗组为规范化物理治疗+药物治疗,对照组为传统物理治疗+药物治疗。治疗1月后,分析2组的治疗效果。结果治疗组有效率为95.35%,对照组有效率为56.76%,2组间比较差异有统计学意义;同时观察2组患者治疗前后的睑酯排出能力、睑酯性状及泪膜破裂时间(break-up time of tear film,BUT),发现2组患者治疗前后的睑酯排出能力评分、睑酯性状评分、BUT时间比较差异有统计学意义。结论规范化物理治疗MGD能够有效排出堆积的睑板腺异常睑酯,减轻局部炎症反应,缓解患者的干眼症状,该治疗成本低,疗效佳,易推广。
文摘The tear film covers the anterior eye and the precise balance of its various constituting components is critical for maintaining ocular health.The composition of the tear film amphiphilic lipid sublayer,in particular,has largely remained a matter of contention.The limiting concentrations of lipid amphiphiles in tears have also posed considerable challenges to their detection and accurate quantitation.Using systematic and sensitive lipidomic approaches,we reported the most comprehensive human tear lipidome to date;and conferred novel insights to the compositional details of the existent tear film model,in particular the disputable amphiphilic lipid sublayer constituents,by demonstrating the presence of cholesteryl sulfate,O-acyl-ω-hydroxy fatty acids,and various sphingolipids and phospholipids in tears.Lipidomic analysis of human tear fluid from patients with various subtypes of dry eye syndrome(DES)revealed structure-specific lipid alterations in DES,which could potentially serve as unifying indicators of disease symptoms and signs.The meibomian glands constitute the predominant source of lipid supply to the human tear fluid.Meibomian gland dysfunction(MGD)is a leading cause of evaporative dry eye and ocular discomfort,characterized by an unstable tear film principally attributed to afflicted delivery of lipids to the ocular surface.We investigated the longitudinal tear lipid alterations associated with disease alleviation and symptom improvement in a cohort of MGD patients undergoing eyelid-warming treatment for 12 weeks.Our preliminary data indicated that excess ocular surface phospholipase activity detrimental to tear film stability could be alleviated by eyelid warming alone without application of steroids and identify tear OAHFAs as suitable markers to monitor treatment response in MGD.
