热敷按摩改善睑板腺功能障碍患者的白内障术后疗效

目的：评价白内障术前进行眼睑热敷联合睑板腺按摩对白内障合并轻中度睑板腺功能障碍（MGD） 患者白内障术后临床效果的改善。方法：前瞻性临床研究。收集2019年9月至2020年6月于温州医科大学附属眼视光医院杭州院区就诊的50～85岁轻中度MGD合并白内障的患者，按随机数字表法分为实验组和对照组，实验组先接受3次眼睑热敷联合睑板腺按摩治疗再行白内障手术，对照组直接行白内障手术。分别记录MGD治疗前、治疗后以及白内障术后1周、1个月、3个月时的泪液分泌试验（SⅠT）、泪膜破裂时间（TBUT）、角结膜染色评分、睑板腺功能评分；眼表综合分析仪（keratograph 5M）检查并记录非侵入性泪河高度（NITMH）、非侵入性泪膜破裂时间（NITBUT）和睑板腺缺失范围（MGL）；采用眼表疾病指数（OSDI）问卷得分进行评估。使用广义估算方程（GEE）、广义线性混合模型（GLMM）、独立样本t检验及Mann-Whitney U检验进行数据分析。结果：共纳入77例（77眼）， 最终纳入分析68例（68眼），每组34例。实验组在MGD治疗后，睑缘形态、睑板腺排出能力、SⅠT、 TBUT及OSDI评分较MGD治疗前明显好转（P<0.05）；角膜点染在白内障术后1周时较治疗前增加 （P=0.002），至术后1个月时恢复至治疗前水平。组间比较发现，实验组睑脂质量变化量在白内障术后各时间点均明显优于对照组（P<0.05）；白内障术后1周时，实验组睑缘形态的变化量小于对照组， 术后1个月时，NITMH变化量小于对照组，而OSDI评分变化量大于对照组（P<0.05），实验组症状及体征更轻；对照组在白内障术后1周时，睑缘形态及SⅠT明显变差，至术后1个月时恢复至术前水平； 睑脂质量在术后1周时变差，NITMH在术后1个月时减少，二者至术后3个月时恢复至术前水平。结论： 白内障术前采用眼睑热敷联合睑板腺按摩治疗MGD，可改善术后睑板腺功能状态，缓解干眼症状。

Warm Compresses and Meibomian Gland Expression Improve Postoperative Effects for Cataract Patients with Meibomian Gland Dysfunction

Objective: To evaluate the clinical efficacy of using warm compresses on the eyelid combined with meibomian gland expression preoperatively in cataract patients with mild to moderate meibomian gland dysfunction (MGD). Methods: This study was based on a prospective clinical research design. Mild to moderate MGD patients 50-85 years old who underwent cataract surgery in the Eye Hospital, Wenzhou Medical University from September 2019 to June 2020, were divided randomly into an experimental groupand a control group. The experimental group were treated with warm compresses and meibomian gland expression three times before cataract surgery, while the control group underwent cataract surgery without pretreatment. The parameters included Schirmer Ⅰ test (SⅠT), tear break-up time (TBUT), corneal and conjunctival stain, lid margin, expressibility, meibum quality, keratography-5M including noninvasive tear meniscus height (NITMH), noninvasive tear break-up time (NITBUT), and meibomian gland loss (MGL), and the ocular surface disease index (OSDI) questionnaire were measured before and after MGD treatment, and 1 week, 1 month and 3 months postoperatively. Data was analyzed by a generalized estimation equation (GEE), generalized linear mixed model (GLMM), independent-samples t test and Mann-Whitney U test. Results: A total of 68 patients (68 eyes) were included for analysis, with 34 patients in each group. In the experimental group, the lid margin, meibomian expression, SⅠT, and TBUT and OSDI scores were significantly improved after MGD treatment (P<0.05). Corneal fluorescein staining increased significantly one week after cataract surgery (P=0.002), and returned to baseline level 1 month postoperatively. There was significantly less deterioration in meibomian quality in the experimental group compared to the control group during the follow-up period after surgery (P<0.05). Worsening of the lid margin was significantly lighter than that of the control group at 1 week after cataract surgery; the change in NITMH was less, and OSDI scores were higher in the experimental group than those in the control group at 1 month after cataract surgery (P<0.05). In the control group, the lid margin and SⅠT deteriorated significantly 1 week postoperatively and had restored to preoperative levels at 1 month after surgery. Meibomian quality deteriorated 1 week postoperatively, while NITMH decreased at 1 month after surgery, and both of these had recovered to preoperative levels at the 3-month follow-up. Conclusions: Preoperative management of MGD with warm eyelid compresses and meibomian gland expression can improve the function of the meibomian gland and alleviate dry eye symptoms after cataract surgery.