目的评价角膜绷带镜防治轻度睑板腺功能障碍(MGD)患者白内障术后干眼的有效性和安全性。
方法采用非随机对照临床研究方法,纳入2020年6月至2021年2月于烟台毓璜顶医院眼科行超声乳化白内障摘出联合人工晶状体(IOL)植入手术的白内障合并轻度MGD患者60例60眼,根据患者意愿将其分为绷带镜佩戴组和对照组,每组30眼,其中绷带镜佩戴组术眼术后连续佩戴角膜绷带镜14 d,第14天复查时取出;对照组术眼术毕未佩戴角膜绷带镜,2个组术眼术后用药均一致。术前及术后第1、7、14天,采用裂隙灯显微镜观察眼前节结构及炎症表现;采用标准对数视力表获得最佳矫正视力(BCVA);采用眼表疾病指数(OSDI)问卷对术眼眼表症状进行评分;采用眼表综合分析仪评估术眼睑板腺情况并记录非侵入性首次泪膜破裂时间(NIFBUT);采用角膜荧光素钠染色(CFS)观察术眼角膜上皮有无缺损并对角膜着色情况进行评分。
结果术后第1、7、14天,2个组术眼均未出现炎症反应及并发症;术后不同时间点BCVA总体比较差异有统计学意义( F 时间=3.610, P=0.016),其中各组术后第7天BCVA较术后第1天提高,术后第14天BCVA较第1天和第7天明显提高,差异均有统计学意义(均 P<0.05)。2个组术后不同时间点OSDI评分总体比较差异均有统计学意义( F 组别=31.219, P<0.001; F 时间=15.672, P<0.001),其中2个组术后第7天和第14天绷带镜佩戴组OSDI评分明显低于对照组,术后第14天OSDI评分均明显低于术后第1天和第7天,差异均有统计学意义(均 P<0.05)。对照组术后第7天和第14天术眼NIFBUT值分别为(6.62±0.93)s和(8.02±1.13)s,绷带镜佩戴组分别为(9.81±0.91)s和(10.03±0.49)s,2个组总体比较差异有统计学意义( F 组别=2.351, P=0.037),其中术后第7天和第14天绷带镜佩戴组NIFBUT值均高于相应时间点对照组,差异均有统计学意义(均 P<0.05)。对照组术后第7天和第14天高CFS评分眼数均多于绷带镜佩戴组,差异均有统计学意义( χ 2 =7.391, P=0.025; χ 2 =9.317, P=0.002)。
结论轻度MGD患者白内障术后佩戴角膜绷带镜无明显眼部不良反应,并可促进角膜上皮生长,提高泪膜稳定性,改善干眼症状,减轻术后出现的干眼不适。
ObjectiveTo evaluate the efficacy and safety of corneal bandage lens in the treatment of dry eye after cataract surgery in patients with mild meibomian gland dysfunction (MGD).
MethodsA non-randomized controlled clinical study was conducted.Sixty eyes of 60 patients with mild MGD after cataract surgery were enrolled in Yantai Yuhuangding Hospital from June 2020 to February 2021.The patients were divided into bandage lens group and control group according their willingness, with 30 eyes in each group.All the patients received phacoemulsification and intraocular lens implantation and were administered with the same postoperative medication.Patients in bandage lens group wore lenses for 14 days continuously after the operation.Patients in control group did not wear the corneal bandage lens after the operation.The structure and inflammation of the anterior segment were observed with a slit-lamp microscope before operation and on days 1, 7, and 14 after the operation.Best corrected visual acuity (BCVA) was obtained using a standard logarithmic visual acuity chart.Ocular surface symptoms were evaluated via an ocular surface disease index (OSDI) questionnaire.The intraoperative changes of meibomian glands were assessed with an ocular surface analyzer and the non-invasive first tear film break-up time (NIFBUT) was recorded.Corneal epithelium defects were observed by corneal fluorescein sodium staining (CFS). This study adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Yantai Yuhuangding Hospital (No.2021-363). Written informed consent was obtained from each patient before any medical examination.
ResultsOn the 1st, 7th, and 14th day after surgery, no inflammatory reaction or complication was observed in both groups.Statistically significant differences in BCVA among different postoperative time points were found ( F time=3.610, P=0.016). BCVA on the 7th day after surgery were higher than that on the 1st day after surgery, and the BCVA on the 14th day after surgery were significantly higher than those on the 1st and 7th day after surgery in both groups, with statistically significant differences (all at P<0.05). There were statistically significant differences in OSDI scores between the two groups at different postoperative time points ( F group=31.219, P<0.001; F time=15.672, P<0.001). The OSDI scores of bandage lens group were significantly lower than those of control group on the 7th and 14th day after surgery, OSDI scores in both groups on the 14th day after surgery were significantly lower than those on the 1st and 7th day after surgery, with statistical significance (all at P<0.05). The NIFBUT values on the 7th and 14th day after surgery were (6.62±0.93)s and (8.02±1.13)s, in control group, bandage lens group and (9.81±0.91)s and (10.03±0.49)s in bandage lens group, with a statistically significant difference between them ( F group=2.351, P=0.037), and the NIFBUT values of bandage lens group on the 7th and 14th day after surgery were higher than those of control group, with statistically significant differences (both at P<0.05). The number of high CFS score eyes of bandage lens group were lower than those of control group on the 7th and 14th day after surgery, and the differences were statistically significant ( χ 2 =7.391, P=0.025; χ 2 =9.317, P=0.002).
ConclusionsFor patients with mild MGD after cataract surgery, wearing bandage contact lens has no obvious ocular adverse reaction and can promote the growth of corneal epithelium, enhance the stability of tear film, improve dry eye symptoms, and relieve dry eye manifestations after surgery.
潘彦丽,梁艳,李元彬. 佩戴角膜绷带镜对轻度MGD患者白内障术后干眼防治的安全性及有效性[J]. 中华实验眼科杂志,2022,40(05):448-453.
DOI:10.3760/cma.j.cn115989-20211216-00696版权归中华医学会所有。
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李元彬:参与选题、研究设计、研究数据审核和分析、文章智力性内容的修改及论文最终定稿;潘彦丽:参与设计试验、研究实施、数据采集和分析、文章写作和修改;梁艳:数据统计分析、研究设计及文章修改

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