Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction

Meibomian gland dysfunction (MGD) is a major cause of dry eye, affecting millions worldwide. Intraductal meibomian gland probing (MGP) aims to open obstructed meibomian glands using a small probe to promote meibum secretion. MGP has received increasing interest since 2010, and we critically evaluated the literature on the efficacy and safety of MGP. Despite positive results of MGP on dry eye symptoms in early single-group studies, MGP was not shown to consistently outperform controls in later controlled trials. Furthermore, MGP alone did not show improvement beyond placebo in the only placebo-controlled RCT conducted. Overall, the procedure appears safe. Self-limited intraoperative bleeding was frequent, but no major complications were reported. In conclusion, MGP has not yet been shown to be an effective treatment for MGD. Larger placebo-controlled trials need to be conducted to establish the potential effect of this novel treatment modality.     

睑板腺功能障碍研究进展

睑板腺功能障碍(meibomian gland dysfunction,MGD)以睑板腺终末导管阻塞和睑板腺分泌物的质量或数量改变为特征.睑板腺分泌的脂质成分发生相应改变,造成泪膜的稳定性下降和泪液蒸发量增加,从而导致干眼发生.目前MGD的发病原因尚不明确,临床上采取的治疗往往是对症治疗.本文主要对MGD的泪膜脂质变化及其国内外诊治进展进行总结.     

Prevalence of meibomian gland dysfunction in staffs and faculty members of a Chinese university

AIM: To assess the prevalence of meibomian gland dysfunction (MGD) in staffs and faculty members of Sichuan University, China.METHODS: The records of the annually systemic physical examination of 4404 consecutive staffs and faculty members of Sichuan University were analyzed retrospectively. Ocular symptoms and signs of ocular surface were evaluated.RESULTS: MGD was diagnosed in 1424 participants (32.3%), with a mean age of 43.0±9.6y. Of these, 718 (50.4%) were females and no significant difference was found between males and females. The highest prevalence was found in the age 50-59y (36.0%). Logistic regression analysis showed that age is an impact factor of MGD (P<0.001, odds ratio=1.014).CONCLUSION: The prevalence of MGD in staffs and faculty members of a Chinese university is 32.3%, and increases with age.     

提高对睑板腺功能障碍的认识 重视睑板腺功能障碍相关性干眼的药物治疗

睑板腺功能障碍（MGD）是临床常见的眼表疾病,以睑板腺终末导管的阻塞和／或睑板腺分泌物质或量的改变为特征,导致脂质向泪膜的排出减少,引起泪液蒸发过强。睑缘和睑板腺的炎症是引起睑板腺阻塞,进而导致MGD的直接原因,可引起眼表功能的异常。MGD的诊断主要依靠临床症状与体征,其症状与干眼的症状相似,因此无诊断特异性。体征主要包括睑缘形态的变化、睑板腺分泌异常和睑板腺缺失。MGD的治疗方法包括热敷、清洁睑缘、促进睑板腺的分泌、抗菌、抗炎治疗及润滑眼表,中度、重度MGD患者可给予必要的抗炎治疗,常用的抗炎药物有糖皮质激素、非甾体类抗炎药及免疫抑制剂。临床医师在进行眼部疾病的检查时应重视睑板腺的功能状态,尤其在角膜屈光手术及内眼手术前更应重视MGD的筛查,以免术后引起严重的眼表并发症,有效规避医疗风险。     

睑板腺功能障碍患者睑缘形态与睑板腺形态学的相关性研究

目的 研究睑板腺功能障碍（MGD）患者睑缘形态与睑板腺形态的相关性。设计 横断面研究。研究对象 2019年北京同仁医院行Lipiflow热脉冲治疗前的MGD患者30例（30眼）。方法 通过眼前节照相技术和Oculus眼表分析仪拍摄睑缘和睑板腺,并依据睑缘形态、睑板腺主体部形态、睑板腺开口和分泌物性状进行分类。睑缘形态分为肥厚、充血、角化和变形;睑板腺主体部形态分为缺失、白色节段、导管膨胀、萎缩、扭曲和分叉;睑板腺开口形态分为圆形、脂帽、脂塞和脂栓。依上述形态进行评分,运用Spearman相关分析研究睑缘形态与睑板腺形态的相关性。主要指标 睑缘及睑板腺形态评分,睑缘及睑板腺形态学相关系数（r）。结果 睑板腺开口形态与分泌物性状之间呈正相关（r=0.590,P=0.001）,睑板腺白色节段与睑板腺开口形态呈正相关（r=0.439,P=0.015）;睑板腺萎缩和分叉与睑板腺的分泌物性状呈负相关（r=-0.349,-0.374;P=0.048,0.042）。在睑缘形态中,睑缘角化的评分与睑缘形态总评分呈正相关,且相关关系最强（r=0.842,P＝0.000）;睑缘角化与睑板腺开口形态改变呈正相关（r=0.517,P=0.003）。在睑板腺形态中,睑板腺白色节段评分与睑板腺总评分呈正相关,且相关关系最强（r=0.535,P＝0.002）。结论 MGD患者睑缘形态与睑板腺形态部分存在相关关系。睑板腺白色节段作为睑板腺主体部的形态评估指标更为合理;睑缘角化作为睑缘的形态评估指标更为合理,且睑缘角化与睑板腺开口的形态改变相关。（眼科, 2020, 29： 355-360）     

睑板腺功能障碍的相关危险因素

睑板腺功能障碍(meibomian gland dysfunction,MGD)是一种慢性、弥漫性睑板腺异常,它通常以睑板腺终末导管的阻塞和(或)睑板腺分泌物质或量改变为特征.MGD的危险因素错综复杂.任何影响睑板腺功能的原因如局部因素、药物因素、全身情况、先天性因素等均可导致MGD,有时可能为众多危险因素综合作用的结果.临床工作中眼科医生应关注MGD相关危险因素,以便针对性治疗.     

睑板腺功能障碍的治疗进展

睑板腺功能障碍（meibomianglanddysfunction,MGD）是一种常见的眼表疾病,是多种睑板腺异常的总称,包括其结构异常和分泌物性质的异常,可引起眼睑炎症和泪液不稳定以及其他眼表疾病,其中最常见的病变是后部睑缘炎和脂质缺乏性（1ipidteardeficiency,LTD）干眼症。既往MGD的治疗主要为眼睑清洁、热敷、睑板腺按摩、营养治疗、激素以及抗生素应用等,近年来物理疗法、免疫调节、环境调节等治疗方法有了新的进展,抗生素的治疗机理研究也有新的发现。     

The significance of meibomian gland changes in asymptomatic children

Purpose

To evaluate meibomian gland morphology and function in children without ocular discomfort.

腺管探通术治疗睑板腺功能障碍的临床观察

目的探讨睑板腺腺管探通术治疗睑板腺功能障碍（MGD）的临床疗效及安全性。方法前瞻性配伍组设计。111例睑板腺功能障碍患者,按性别年龄相匹配分为3组,每组37人（37眼）,选择症状体征较重的眼作为观察眼。常规治疗组采用抗生素激素滴眼液+人工泪液+局部物理治疗;腺管探通术组在常规治疗组的治疗基础上用直径仅76 ?滋m的不锈钢探针（美国Rhein Medical公司）,每只眼探通6～9个睑板腺腺管;腺管探通联合管内注药组在腺管探通组治疗基础上,探通术中管内注入适量妥布霉素地塞米松滴眼液。分别于治疗前和治疗后1个月观察MGD患者主观症状指标眼表疾病指数（OSDI）量表、泪膜破裂时间（BUT）、基础泪液分泌试验（SIT）检查、角膜荧光素染色（CFS）、裂隙灯显微镜下睑缘评分共5项指标的变化并做对比分析。对实施探通术2组的MGD患者分别于探通前及探通后1个月进行共聚焦显微镜检查,观察睑板腺腺泡单位有无损伤改变,以评价探通术的安全性。组内定量指标比较采用配对t检验,多组之间比较采用配伍组设计的两因素方差分析,差异有显著性后采用 q检验进行两两比较。结果①3组MGD患者治疗前OSDI、BUT、CFS、SIT、裂隙灯下睑缘评分共5项观测指标基线值对比差异无统计学意义。②治疗后1个月3组之间5项检测指标差异有统计学意义（F=4.68、4.17、3.98、3.67、4.12,P＜0.05）;腺管探通术组与腺管探通联合管内注药组各项观测指标改善程度均优于常规治疗组,差异有统计学意义（P＜0.05）。腺管探通联合注药组经治疗后改善程度虽优于单纯探通术组,但差异无统计学意义。③实施探通术的2组MGD患者治疗后5项观测指标较治疗前均有显著改善,差异有统计学意义（腺管探通术组：t=2.543、2.343、2.456、2.132、2.237;腺管探通联合管内注药组：t=2.713、2.443、2.496、2.143、2.249,P均＜0.05）。常规治疗组MGD患者经治疗后与术前相比虽有改善,但差异无统计学意义。④共聚焦显微镜下睑板腺腺泡单位因光学切面不同,呈现不同形态,有圆形、卵圆形、长条形、不规则形等,腺泡外圈为轮胎样上皮细胞,伴有高亮反光颗粒,胞腔内呈灰色伴点状高反光分泌物,团块状聚集分布,排列不规整。探通后未见萎缩腺泡增加或疤痕形成。结论睑板腺腺管探通术能直接缓解睑板腺管阻塞,从而快速地缓解阻塞性MGD患者的症状和体征,是一种新的安全有效的治疗方法。     

Factors affecting meibomian gland area loss in symptomatic adults

AIM: To characterize the distribution of meibomian gland (MG) area loss (MGL) and its relationship with demographic characteristics, mites, and symptoms. METHODS: This retrospective observational study included patients who visited the Dry Eye Clinic of Shenzhen Eye Hospital between June 2020 and August 2021. General patient characteristics, ocular symptoms, Demodex test results of the eyelid edges, and the results of a comprehensive ocular surface analysis were collected. MGL was analyzed using Image J software. RESULTS: This study enrolled 1204 outpatients aged 20-80 (40.70±13.44)y, including 357 males (29.65%) and 847 females (70.35%). The patients were classified into mild (n=155; 12.87%), moderate (n=795; 66.03%), severe (n=206; 17.11%), and extremely severe (n=48; 3.99%) MGL groups. MGL was significantly larger in female than in male (P=0.006). The degree of MGL also significantly differed in age (P<0.001) and the more numbers of mites with severity (P<0.001). Multivariate disordered multinomial logistic regression analysis identified that female sex, older age, secretory symptoms, and a large number of mites were risk factors for MGL (P<0.05). CONCLUSION: Patients with MGL are more likely to be older, female, more numbers of mites, and increased secretion.     

Prevalence of pinguecula and pterygium in a general population in Spain

Purpose

To determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain.

Methods

An age-stratified random sample of 1155 subjects ≥40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40–96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated.

Results

The prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9–51.9). This prevalence increased significantly with aging (P=0.002) and was higher in men (56.4% 95% CI: 50.0–62.7) than in women (42.7% 95% CI: 37.8–47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3–7.9). This prevalence also increased significantly with aging (P=0.005) and was 4.8% (95% CI: 2.6–8.4) in men and 6.5% (95% CI: 4.5–9.3) in women (P=0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (OR_a): 3.08; 95% CI: 1.60–5.95), pterygium with fluorescein staining (OR_a: 2.64; 95% CI: 1.08–6.46) and both disorders with outer activity (OR_a: 2.07; 95% CI: 1.36–3.15 and 2.28; 95% CI: 1.04–4.98, respectively).

Conclusions

Pinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity.     

睑板腺功能障碍的治疗进展

睑板腺功能障碍(meibomian gland dysfunction,MGD)在过去几十年中已经逐渐受到临床医师的重视.近年来临床医师使用物理热敷或热装置、人工泪液、局部及全身抗生素、糖皮质激素、环孢素A、调节内分泌、改善生活方式等方法治疗MGD,获得较好的治疗效果,并提出分级治疗的理念.本文旨在介绍近年来MGD治疗理念的变化和治疗方法的进展.     

睑板腺功能障碍治疗进展

睑板腺功能障碍(meibomian gland dysfunction,MGD)对眼表损害大,影响眼部手术预后、降低患者生活质量,越来越引起临床眼科医师的重视.MGD的治疗主要为眼睑清洁、热敷、睑板腺按摩、营养治疗及抗生素等.近年来一些安全有效、方便易行的仪器用于临床,如眼睑加热装置、强脉冲光疗法、显微探针睑板腺疏通等,可改善患者的症状及体征,取得较好的疗效.