泪道栓塞术治疗干眼症的临床效果

目的 探讨新型Smart PLUG泪道栓子治疗顽固性干眼的临床疗效。方法 选择2004年7月至2004年10月于北京大学眼科中心就诊的43例（72只眼）使用人工泪液疗效不理想的顽固干眼患者采用新型Smart PLUG泪道栓子进行泪道栓塞术治疗,分别于术前3d及术后1周、3个月针对干眼症状对患者进行问卷调查,并同时进行裂隙灯显微镜检查、角膜荧光素染色、泪液膜破裂时间（BUT）、Schirmer Ⅰ试验（STⅠ）及结膜印记细胞学检查（IC）,以观察临床疗效。结果 调查问卷中,干眼患者最多的主诉是干涩、异物感、视疲劳、眼红。术后患者上述症状明显减轻,甚至消失。与术前相比,37例（62只眼）荧光素染色角膜上皮点状着色消失,下睑缘明显有泪河线形成。与术前相比,BUT和STI明显增加和延长,结膜细胞印记学检查显示患者的结膜上皮细胞鳞状化生现象有一定减轻。结论 使用Smart PLUG泪道栓子进行泪道栓塞术可以明显改善干眼患者的临床症状,增加患者眼球表面泪液量,改善泪膜稳定性,是治疗顽固性干眼的有效方法之一。     

人工泪液联合重组人表皮生长因子滴眼液对白内障囊外摘除术后干眼疗效观察

目的:探讨人工泪液联合重组人表皮生长因子滴眼液治疗白内障囊外摘除术后干眼的临床疗效。方法:选择白内障囊外摘除术后有干眼症状的患者62例62眼,随机分为治疗组和对照组两组,每组31例31眼,治疗组采用人工泪液(泪然)和重组人表皮生长因子(金因舒)滴眼,对照组单用人工泪液。记录患者用药前和用药后2,4wk的干眼症状评分,裂隙灯下观察泪膜破裂时间(BUT)、泪液分泌试验(SchirmerⅠtest,SⅠt)、角膜荧光素染色(FL)情况。结果:治疗前两组干眼症状评分、BUT,SⅠt,FL差异均无统计学意义(P>0.05),用药后2,4wk,治疗组干眼症状评分、BUT,SⅠt,FL与对照组比较,差异均有显著统计学意义(P<0.01)。结论:人工泪液联合重组人表皮生长因子滴眼液治疗白内障囊外摘除术后干眼疗效优于单用人工泪液,效果显著。     

泪然联合贝复舒眼液对青光眼滤过术后干眼疗效观察

目的:探讨人工泪液(泪然)联合重组牛碱性成纤维细胞生长因子(贝复舒)滴眼液治疗青光眼滤过术后干眼的临床疗效。方法:选择青光眼滤过术后有干眼症状的患者60例60眼,随机分为治疗组和对照组两组,每组30例30眼,治疗组采用人工泪液和重组牛碱性成纤维细胞生长因子滴眼,对照组单用人工泪液。记录患者用药前和用药后2,4wk的干眼症状评分,裂隙灯下观察泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、角膜荧光素染色(FL)情况。结果:治疗前两组干眼症状评分,BUT,SⅠt,FL差异均无统计学意义(P>0.05),用药后2,4wk治疗组干眼症状评分,BUT,SⅠt,FL与对照组比较,差异均有显著统计学意义(P<0.01)。结论:人工泪液联合重组牛碱性成纤维细胞生长因子滴眼液治疗青光眼滤过术后干眼疗效优于单用人工泪液,效果显著。     

人工泪液与重组人表皮生长因子衍生物眼液对翼状胬肉术后干眼疗效观察

目的 探讨人工泪液联合重组表皮生长因子衍生物滴眼液治疗翼状胬肉术后干眼的疗效.方法 选择翼状胬肉术后有干眼症状的患者82例(96只眼),随机分为治疗组和对照组两组,每组41例(48只眼),治疗组给予人工泪液(泪然)和重组表皮生长因子衍生物(金因舒)治疗,对照组单用人工泪液,裂隙灯下观察,记录用药前及用药后2周、4周泪膜破裂时间(BUT),泪液分泌实验(schimer-1),角膜荧光素染色(FL)以及干眼症状的改善程度.结果 治疗前,治疗组与对照组Schirmer-1、BUT、FL差异无统计学意义(P>0.05);用药后2周、4周,治疗组schimer-1、BUT、FL以及临床症状的改善与对照组比较,差异有统计学意义(P<0.01).结论 人工泪液联合重组表皮生长因子衍生物滴眼液治疗翼状胬肉术后干眼疗效优于单用人工泪液,效果显著.     

泪小管栓子治疗干眼的临床观察

干眼(Dryeye)是由于泪液生成不足或泪液蒸发过强并致泪膜不稳定引起眼表病变而产生眼部一系列不适症状.泪液生成不足型干眼病是由于泪液生成功能紊乱或泪液由泪腺排人结膜囊受阻所致.通过阻止泪液的排泄而增加眼表泪液从而减轻干眼症状.本文以不可吸收性泪小管栓子栓塞干眼患者泪小管后,观察干眼症状的减轻,客观检查进行比较,以及并发症的发生情况来观察泪小管栓子治疗干眼的应用前景.     

EXTEND可吸收合成泪道塞治疗干眼的临床观察

目的评价EXTEND可吸收合成泪道塞（EASI）治疗干眼的有效性、安全性及临床应用价值。方法对42例（42眼）轻中度水液缺乏性干眼（ATD）患者采用EASI进行泪道栓塞治疗。于治疗前、治疗后2周、1个月和3个月对患者行干眼症状的问卷调查,同时观察泪河高度（TMH）、泪膜破裂时间（BUT）、荧光素染色、丽丝胺绿染色和SchirmerⅠ试验（STⅠ）,治疗前和3个月时行结膜印迹细胞学检查（IC）。结果EASI植入后2周、1个月和3个月时干眼症状评分分别为2.60±1.45、2.30±1.46和2.37±1.78,较治疗前（3.62±1.53）下降,差异有统计学意义（F=35.576,P〈0.01）。治疗后满意率95.24%。治疗后人工泪液点眼平均次数（2.38±2.28）较治疗前（5.14±2.50）减少,差异有统计学意义（F=10.308,P〈0.01）。EASI植入后,干眼患者泪河高度增加（F=36.371,P〈0.01）,BUT（F=24.83,P〈0.01）和STⅠ（F=4.399,P=0.006）明显延长,角膜荧光素染色（F=12.088,P〈0.01）和结膜丽丝胺绿染色（F=4.952,P=0.003）减轻。治疗后3个月时结膜上皮细胞鳞状化生现象有一定减轻。治疗期间未见严重并发症。结论EASI治疗ATD可明显减轻干眼症状,改善泪液的质和量,减少人工泪液点眼次数,是一种短期内治疗干眼安全有效的方法。     

润目增液汤联合人工泪液治疗干眼症的疗效

目的:观察润目增液汤联合人工泪液在干眼症治疗中的临床疗效.方法:采用临床随机对照的研究方法,将临床收集的160例320眼干眼症患者分为两组,分别为治疗组和对照组,每组各80例160眼,治疗组的患者每日口服润目增液汤,频率1剂/d,同时每日予人工泪液滴眼,频率3次/d;对照组的患者每日仅予人工泪液滴眼,频率3次/d,疗程为3mo.记录患者用药前、用药后1、3mo的干眼自觉症状,裂隙灯下观察泪膜破裂时间(BUT)、角膜荧光素染色(FL)、泪液分泌试验(Schirmer Ⅰ test,SⅠt)及疗效情况.结果:治疗前两组干眼患者BUT、FL、SⅠt三项差异均无统计学意义(P>0.05);用药后1、3mo,治疗组干眼BUT、FL、SⅠt及总体疗效相比于对照组,有显著的统计学差异(P<0.05).结论:润目增液汤联合人工泪液用于干眼症治疗的疗效优于单纯使用人工泪液,并且疗效显著.     

泪道栓子治疗重度干眼症的临床研究

目的对比研究新型泪道栓子Smart PlugTM和人工泪液治疗重度干眼症的临床效果。方法观察94例(120眼)重度干眼症患者,随机分为对照组和试验组。对照组采用人工泪液滴眼,试验组予以下泪小点植入Smart Plug^(TM)泪道栓子,对比评价2组治疗前及治疗后1个月、3个月的主观症状评分、泪液分泌试验、泪膜破裂时间(BUT)及角膜荧光染色(FL)评分情况。结果试验组和对照组在治疗前主观症状评分分别为7.62±1.03和7.65±1.09,泪液分泌试验分别为(2.63±0.71)mm和(2.53±0.77)mm,BUT分别为(2.67±0.80)和(2.62±0.76)s,角膜FL评分分别为9.08±1.55和8.75±1.56,2组差异均无统计学意义(P值均>0.05)。而在治疗1个月后以及治疗3个月后,2组间各项指标差异均有统计学意义(P<0.05),且试验组的主观症状评分、泪液分泌试验、BUT及角膜FL评分改善较对照组更为明显。结论使用Smart PlugTM泪道栓子可以明显改善重度干眼症的临床症状,且治疗效果优于常规人工泪液的治疗。     

下泪点封闭术治疗中重度干眼症的疗效评价

探讨下泪点封闭术用于药物治疗效果不佳的重度干眼症患者的临床疗效。 方法：选择2010-01/2011-01在我院眼科门诊就诊的19例38眼使用人工泪液效果欠佳的中重度干眼症患者,采用下泪点封闭术进行治疗。分别于术前3d及术后1wk;3,6mo进行裂隙灯显微镜检查泪河高度、角膜荧光素染色、泪液膜破裂时间(BUT)、SchirmerⅠ试验(SⅠt)以观察临床疗效。 结果：术前干眼患者主诉多为干涩、异物感、视疲劳。术后患者上述症状明显减轻,甚至消失。与术前相比, 15例30眼荧光素染色角膜上皮点状着色消失,下睑缘明显有泪河线形成。与术前相比,BUT和SⅠt明显增加和延长。 结论：下泪点封闭术可明显改善干眼症患者的临床症状,增加眼表的泪液量,打破干眼症泪液分泌的恶性循环,对于药物治疗效果不佳的中重度干眼症患者是一种简便有效的方法。     

人工泪液治疗儿童干眼症的疗效观察

目的:观察人工泪液治疗儿童干眼症的疗效及安全性.方法:对58例116眼经泪膜破裂时间(tear break-up time,BUT)、泪液分泌试验(Schirmer Ⅰ test,SⅠt)、泪河高度、角膜荧光染色、睑板腺功能检查方法确诊为干眼症的儿童患者进行人工泪液治疗,疗程为1 mo,复查时再次行上述检查,对各观察指标进行统计分析.结果:儿童于眼症患者58例116眼治疗前BUT为6.03±1.19s,SⅠt为7.67±2.32mm/5min,泪河高度为0.20±0.02mm,角膜荧光染色为1.02±0.13分,睑板腺功能评分为2.45 ±0.86分.其中31例62眼为脂质缺乏型干眼、20例40眼为水液缺乏型干眼、7例14眼为其他类型.根据其分型,给予相应的人工泪液治疗,治疗1mo后患者的临床症状明显改善,BUT为13.72±1.83s,SIt为12.38±3.64mm/5min,泪河高度为0.36±0.08mm,角膜荧光染色为0.03±0.24分,睑板腺功能评分为1.57±0.93分.各观察指标与治疗前相比,差异具有统计学意义(P＜0.05).所有患者在治疗期间均未出现任何不良反应.结论:利用人工泪液治疗儿童干眼是安全、有效的.     

硅泪小管塞在不同干眼症治疗中的应用

目的　评估泪小管塞在不同类型干眼治疗中的效果。方法　随机选择干眼患者 40例( 78只眼 )。其中男性 8例 ( 16只眼 ) ,女性 3 2例 ( 62只眼 ) ;年龄 2 2～ 68岁 ,平均 5 1 4岁 ;包括组Ⅰ :系统性眼干燥综合征 2 0人 ( 3 9只眼 ) ;组Ⅱ :屈光性角膜手术后干眼组 10人 ( 19只眼 ) ;组Ⅲ :其它原因性眼干燥组 10人 ( 2 0只眼 )。首先明确诊断并排除泪道疾病 ,用OdysseyParasol泪管塞(下、上泪点 ) ,随诊 3个月。分组观察眼干燥情况、治疗效果及并发症。治疗前后采用Schirmer试验Ⅰ、泪膜破裂时间及角结膜荧光素染色检查以评估疗效。结果　全部患者共用塞 80枚 ,其中 1例双眼植放上、下泪管塞 ,其余患者均只植放下泪小管塞。治疗结果如下 :( 1)Schirmer试验Ⅰ :治疗前后分别为 :组Ⅰ 1 77± 1 5 3mm及 6 3 1± 5 45mm (t =5 0 11,P <0 0 0 1) ,组Ⅱ 5 42± 1 77mm及10 94± 5 78mm (t =3 11,P <0 0 5 ) ,组Ⅲ 2 5 0± 2 42mm及 6 65± 5 97mm (t =3 91,P <0 0 0 1) ;( 2 )泪膜破裂时间 (BUT) :治疗前后分别为组Ⅰ 2 3 6± 1 5 8s及 5 2 8± 4 0 8s (t =0 996,P >0 0 5 ) ,组Ⅱ 3 2 1± 1 2 3s及 6 5 3± 1 71s (t =3 41,P <0 0 1) ;组Ⅲ 2 5 0± 1 43s及 4 10±1 2 9s (t =3 0 2 ,P     

应用泪道栓塞术治疗顽固性干眼的临床观察

目的 探讨新型Smart Plug泪道栓子治疗视频终端顽固性干眼的临床效果.方法 观察32例(48只眼)视频终端顽固性干眼的患者,选择性在上下泪小点或下泪小点植入泪道栓子,治疗后6个月进行复诊,记录术前、术后6个月症状及泪液分泌试验、泪膜破裂时间的改善情况.结果 经治疗显效40只眼占83%,有效8只眼占17%.结论 使用Smart Plug泪道栓子进行泪道栓塞术可以明显改善干眼患者的临床症状,增加患者眼球表面泪液量,改善泪膜的稳定性,是治疗视频终端顽固性干眼的有效方法之一.     

泪道栓塞术治疗视频终端顽固性眼干燥症的临床观察

目的探讨新型泪道栓子治疗视频终端操作所引起的顽固性眼干燥症的临床效果。方法观察16例（24眼）视频终端操作所引起的顽固性眼干燥症，选择性在上下泪点或下泪点植入Smart Plug泪道栓子，治疗后1月进行复诊，记录术前，术后1月症状及泪液分泌试验，泪膜破裂时间的改善情况。结果经治疗显效20眼占83．33％，有效4眼占16；67％。结论使用Smart Plug泪道栓子进行泪道栓塞术可以明显改善眼干燥症的临床症状，增加眼球表面泪液量，改善泪膜的稳定性．是治疗视频终端顽固件眼干燥痒的右效方法之一。     

The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case-control study

PURPOSE: To evaluate the effectiveness of the autologous serum eyedrops in the treatment of severe dry eye patients. DESIGN: Prospective randomized case-control study. METHODS: Thirty-seven eyes of twenty severe dry eye patients without punctal occlusion were enrolled in this study. After 2 weeks of washout, they were randomly assigned to two groups. Group A patients used only preservative-free artificial tears, and group S patients used only autologous serum eyedrops. We evaluated the results of Schirmer test, fluorescein and rose bengal staining scores, tear film breakup time (BUT), and subjective symptom scores before and 2 weeks after treatment. RESULTS: Mean BUT and fluorescein and rose bengal staining scores, as well as subjective symptom scores, showed significant improvement in the patients assigned to autologous serum eyedrops compared with subjects assigned to preservative-free artificial tears after 2 weeks of treatment. CONCLUSIONS: Autologous serum eyedrops were found effective in the treatment of severe dry eye disease, as evidenced by improvement of tear stability and ocular surface vital staining scores.     

Efficacy of punctum plug treatment in short break-up time dry eye

PURPOSE: To evaluate the efficacy of punctum plug insertion on tear and dynamic visual function in dry eye patients with short break-up time (s-BUT) of the tears. METHODS: A prospective comparative case series design was used. Twenty-seven eyes of 27 dry eye patients with a s-BUT seen at Keio University School of Medicine, Department of Ophthalmology, were studied. Functional visual acuity (FVA) measurements, tear function examinations and ocular surface evaluations including Schirmer test, tear break-up time, fluorescein and Rose Bengal vital staining scores were performed before and 1 month after insertion of punctum plugs (PP) in dry eye patients with s-BUT. Degree of satisfaction with the PP treatment was also graded. RESULTS: Nineteen out of 27 eyes (70.4%) showed a satisfactory outcome with the PP treatment because of decreased subjective dry eye symptoms. On the other hand, six out of eight eyes with an unsatisfactory outcome had epiphora. The visual maintenance ratio value was observed to significantly increase from 0.87 +/- 0.09 to 0.91 +/- 0.07 in eyes with no epiphora, whereas the visual maintenance ratio value significantly decreased from 0.98 +/- 0.10 to 0.86 +/- 0.13 in the group of eyes with epiphora after PP treatment. (p < 0.05) Likewise, FVA significantly improved after PP insertion in the group with no epiphora and decreased in eyes with epiphora. Visual acuity in the conventional Landolt visual testing remained significantly unchanged in both group of eyes with or without epiphora. CONCLUSIONS: FVA was useful in assessing and quantifying vision related symptomatology in s-BUT type of dry eye treated with PP occlusion.     

Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group

OBJECTIVE: To compare the efficacy and safety of cyclosporin A ([CsA] 0.05% and 0.1% ophthalmic emulsions) to vehicle in patients with moderate to severe dry eye disease. DESIGN: Multicenter, randomized, double-masked, parallel-group, 6-month, vehicle-controlled. PARTICIPANTS: A total of 877 patients with defined moderate to severe dry eye disease (292 to 293 in each treatment group). METHODS: Two identical clinical trials; patients were treated twice daily with either CsA, 0.05% or 0.1%, or vehicle. The results of these two trials were combined for analysis. MAIN OUTCOME MEASURES: Efficacy: corneal and interpalpebral dye staining, Schirmer tear test (with and without anesthesia), tear break-up time, Ocular Surface Disease Index (OSDI), facial expression, patient subjective rating scale, symptoms of dry eye, investigator's evaluation of global response to treatment, treatment success, and daily use of artificial tears. Safety: occurrence of adverse events, best-corrected visual acuity, intraocular pressure, biomicroscopy, and blood trough CsA concentrations. RESULTS: Treatment with CsA, 0.05% or 0.1%, gave significantly (P < or = 0.05) greater improvements than vehicle in two objective signs of dry eye disease (corneal staining and categorized Schirmer values). CsA 0.05% treatment also gave significantly greater improvements (P < 0.05) in three subjective measures of dry eye disease (blurred vision, need for concomitant artificial tears, and the physician's evaluation of global response to treatment). There was no dose-response effect. Both CsA treatments exhibited an excellent safety profile, and there were no significant topical or systemic adverse safety findings. CONCLUSIONS: The novel ophthalmic formulations CsA 0.05% and 0.1% were safe and effective in the treatment of moderate to severe dry eye disease yielding improvements in both objective and subjective measures. Topical CsA represents a new pharmacologically based treatment for dry eye disease that may provide significant patient benefits.     

Influence of corneal refractive surgery on the lacrymal film

Functional and clinical signs of ocular surface involvement are observed after corneal refractive surgery (LASIK or PRK) and are evocative of dry eye syndrome. The surgical process induces a total or partial section or abrasion of the corneal-sensitive nerves. This anatomical consequence of surgery is responsible for a lachrymal dysregulation with reduced tear production. Neither technique is currently able to demonstrate its superiority in preserving the lachrymal secretion. These postoperative findings should be clearly explained to patients before surgery and discomfort should be prevented with artificial tears and/or punctual plugs for 1 to 6 months after surgery.     

新型泪小管栓塞材料在治疗干眼症中的临床应用

目的 评估泪小管栓塞材料治疗干眼症的安全性、有效性.方法 观察35例（50只眼）干眼症患者,用上下泪小点或下泪小点植入泪道栓塞,另外29例（50只眼）用泪然滴眼液点眼.观察患者初诊、治疗后2周、1个月、3个月症状／泪液分泌试验和泪液破裂时间以及角膜荧光素染色检查,评估疗效.结果 治疗后2周、1个月、3个月两组的泪液分泌试验和泪膜破裂时间差异有统计学意义,泪道栓塞组的泪液分泌试验和泪膜破裂时间及角膜荧光素染色改善情况明显优于点眼组.结论 用Visplug栓塞和Smart栓塞行干眼症的治疗是安全有效的.     

The importance of the precorneal tear film for the quality of optical imaging.

The optical function of the eye critically depends on the presence of an intact precorneal tear film. Abnormalities of the tear film such as those occurring in the dry eye syndrome or in otherwise irritated eyes may interfere with vision. In 30 patients with dry eyes artificial tears were found to produce statistically significant improvement of vision (p less than 0.001) while no significant changes were seen in the untreated partner eyes. Static perimetry in another 30 patients using the 'macular programme' of the automatic Humphrey 620 perimeter showed artificial tears to increase mean thresholds significantly (p less than 0.001) whereas no significant differences were seen in the untreated partner eyes.