临床研究
ENGLISH ABSTRACT
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
潘彦丽
梁艳
李元彬
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20211216-00696
Safety and effectiveness of corneal bandage lens for the prevention and treatment of dry eye after cataract surgery in patients with mild meibomian gland dysfunction
Pan Yanli
Liang Yan
Li Yuanbin
Authors Info & Affiliations
Pan Yanli
School of Clinical Medicine, Weifang Medical University, Weifang 261053, China
Liang Yan
Department of Ophthalmology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai 264000, China
Li Yuanbin
Department of Ophthalmology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai 264000, China
·
DOI: 10.3760/cma.j.cn115989-20211216-00696
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摘要

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。

睑板腺功能障碍;角膜绷带镜;干眼;白内障超声乳化术;疗效
ABSTRACT

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.

Meibomian gland dysfunction;Corneal bandage lens;Dry eye syndromes;Phacoemulsification;Treatment outcome
Li Yuanbin, Email: tendef.habaeyilnibnauy
引用本文

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

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白内障术后部分患者可出现干眼症状,表现为眼干涩、异物感、用眼持续时间短、一过性视物模糊等。有研究表明,白内障超声乳化术后干眼发生率为98%,且干眼症状和体征在术后第7天就出现,其严重程度随时间延长而改善 [ 1 ]。白内障术后干眼是由多因素导致的,如表面麻醉剂、手术显微镜可能产生的光毒性、角膜神经切断、炎症、杯状细胞丢失和睑板腺功能障碍(meibomian gland dysfunction,MGD)通常被视为潜在的因素 [ 2 , 3 ]。另有研究表明,MGD患者白内障术后干眼症状、睑缘及睑板腺异常均加重,导致患者视觉质量及生活质量严重下降 [ 4 , 5 ]。角膜绷带镜具有缓解疼痛和促进角膜上皮修复的功能,在临床中应用广泛,主要用于治疗影响眼表的各种疾病,包括角膜糜烂、角膜表面不规则、角膜溃疡、干眼和干燥性角膜炎 [ 6 , 7 ]。此外,角膜绷带镜还可用于改善白内障、青光眼、角膜移植、翼状胬肉及屈光等手术后眼表微环境,在一定程度上改善患者的生活质量 [ 5 , 8 , 9 , 10 ]。有研究表明,白内障术后应用角膜绷带镜可以稳定眼表和泪膜,促进角膜愈合,减轻炎症反应,可安全、有效地用于白内障术后患者 [ 11 , 12 ]。但是,佩戴角膜绷带镜可能会引起眼刺痛、灼热感、异物感、眼红、视力下降和眼干等不良反应。目前鲜有研究探讨MGD患者白内障手术后佩戴角膜绷带镜的疗效及安全性。本研究拟评价角膜绷带镜防治MGD患者白内障术后干眼的有效性和安全性,以期为白内障术后干眼的防治提供参考依据。
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备注信息
A
李元彬,Email: tendef.habaeyilnibnauy
B

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

C
中国临床试验注册中心,ChiCTR2100053475
D
Chinese Clinical Trial Register, ChiCTR2100053475
E
所有作者均声明不存在任何利益冲突
F
山东省自然科学基金项目 (ZR2017LH043)
烟台市科技发展计划基金项目 (2021YD025)
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