不同频率强脉冲光联合睑板腺按摩治疗睑板腺功能障碍导致的干眼症患者的临床疗效

目的　探讨不同治疗频率强脉冲光（IPL）联合睑板腺按摩治疗睑板腺功能障碍（MGD）导致的干眼症患者的临床疗效。方法　选取2017年8月至2018年8月于西安市人民医院（西安市第四医院）眼屈光中心就诊的患有MGD导致的干眼症患者30例60眼，最终纳入25例50眼。分别在0周，间隔1周（第1周）、间隔2周（第3周）以及间隔4周（第7周）各进行1次IPL治疗，共治疗4次。对患者进行问卷调查眼表疾病指数量表评分；采用眼表综合分析仪定量测定各间隔治疗期患者泪河高度、平均非侵入性泪膜破裂时间、首次非侵入性泪膜破裂时间，通过红外照相功能检测患者睑板腺缺失情况；对患者睑板腺分泌能力、睑板腺分泌物性状进行评分，并行角膜荧光素染色检查。结果　治疗间隔1周、间隔2周和间隔4周时患者的眼表疾病指数量表评分明显低于治疗前，而治疗间隔1周、间隔2周和间隔4周之间的差异无统计学意义（P>0.05）； 非侵入性泪膜破裂时间、首次非侵入性泪膜破裂时间在各治疗间隔期明显高于治疗前（均为P<0.05）；两两比较显示治疗间隔1周、间隔2周的泪河高度高于治疗前（均为P<0.05），治疗间隔4周的泪河高度较间隔1周和间隔2周下降（均为P<0.05)。治疗间隔1周、间隔2周、间隔4周的睑板腺分泌能力评分均低于治疗前（均为P<0.05）；治疗间隔2周和间隔4周的睑板腺分泌能力评分均低于治疗间隔1周（均为P<0.05）。治疗间隔1周、间隔2周、间隔4周的睑板腺分泌物性状评分均低于治疗前（均为P<0.05）；治疗间隔4周的睑板腺分泌物性状评分低于治疗间隔1周（P<0.05）。治疗间隔1周、间隔2周、间隔4周的角膜荧光素染色等级均低于治疗前（均为P<0.05）。经IPL联合睑板腺按摩治疗4次后患者睑板腺的腺体较治疗前清晰，睑结膜面的新生血管及炎症的红外成像明显减轻，但未见缺失睑板腺腺体恢复。结论　IPL联合睑板腺按摩治疗可缓解MGD导致的干眼症患者的干眼症状，治疗间隔2周可以很好地兼顾疗效和安全性以及患者的经济负担。

Clinical effect analysis of different frequencies on intense pulsed light combined with meibomian gland massage for meibomian gland dysfunction associated with dry eye

Objective　To investigate the clinical effect of different frequency on intense pulsed light (IPL) with and meibomian gland massage for meibomian gland dysfunction（MGD）associated with dry eye.Methods　Thirty patients (60 eyes) with MGD treated at the Eye Refractive Center of Xi’an People’s Hospital (Xi’an Fourth Hospital) from August 2017 to August 2018 were selected. Finally, 50 eyes of 25 patients were included. All the subjects received four times IPL with meibomian gland massage therapy at 0 weeks, the first week, the third week and the seventh week. The ocular surface disease index (OSDI) scale questionnaire score was performed in all subjects, and tear meniscus height (TMH), average noninvasive tear film rupture time (NIBUTav), first noninvasive tear breakuptime (NIBUTf) were measured, meibole secretion status and meibole secretion trait score was conducted, and corneal fluorescein staining were performed to evaluate the efficacy of different treatment frequencies.Results　The scores of ocular surface disease index scale on week 1, week 3 and week 7 were significantly lower than before treatment. However, there were no significant differences between week 1, week 3 and week 7 (P>0.05). NIBUTav and NIBUTf were significantly higher than those before treatment (both P<0.05). The TMHs on week 1 and week 3 were higher than that before treatment (both P<0.05), and the TMHs on week 7 was lower than that on week 1 and week 3. Scores of meibomian gland excretion ability on week 1, week 3 and week 7 were all lower than before treatment (all P<0.05), and week 3 and week 7 were lower than that on week 1 after treatment (both P<0.05). The traits scores of meibomian gland secretion on week 1, week 3 and week 7 were all lower than those before treatment (all P<0.05), and week 7 was lower than that on week 1 after treatment (P<0.05). The corneal fluorescein staining grades on week 1, week 3 and week 7 after treatment were all lower than before treatment (all P<0.05). After IPL combined with meibomian gland massage for 4 times, the glands of the meibomian gland in the patients were clearer than before treatment, and the infrared imaging of new blood vessels and inflammation in the meibomian conjunctiva surface was significantly reduced, but no recovery of missing meibomian glands was observed.Conclusion　IPL combined with meibomian gland massage can reduce the symptoms of MGD patients and improve related indicators of dry eyes. When the treatment frequency is 2 weeks apart, the efficacy and safety can be well achieved.