摘要目的 探讨强脉冲光(IPL)联合睑板腺按摩对睑板腺功能障碍(MGD)的短期疗效.方法 前瞻性随机双盲双眼对照临床研究.选择北京大学第一医院眼科门诊2016年1至3月的连续双眼MGD患者46例,最终纳入44例,平均年龄(46.27±16.94)岁;男性12例,女性32例.按随机数字表选取受试者治疗眼别,治疗眼眼睑接受能量为14～ 16 J/cm2的IPL治疗,对照眼接受能量为0 J/cra2的安慰治疗,IPL治疗后对双眼进行睑板腺按摩.每隔4周重复治疗1次,共3次.在治疗前基线、每次IPL治疗后通过睑板腺评估、SPEED症状问卷评分、泪膜破裂时间、角膜荧光染色、红外线睑板腺照相观察治疗的有效性,通过测量视力、眼压、裂隙灯检查及眼底照相观察其安全性.使用配对秩和检验比较治疗眼和对照眼间及各随访间的治疗评价指标的差异.将Snellen表视力转换为LogMAR视力后,使用配对t检验比较治疗前后BCVA的差异.结果 治疗眼上下睑睑板腺分泌功能评分及泪膜破裂时间随治疗次数的增加均逐步提高(P＜0.05),而对照眼无此改变.其中治疗眼上睑睑板腺分泌功能评分在第一次治疗后较基线增加值为1.00 (0.00,3.75)分,高于对照眼0.00(0.00,0.00)分(Z=-2.999,P=0.003).治疗眼下睑睑板腺分泌功能评分在第二次治疗后较基线增加值为2(-0.75,4.75)分,高于对照眼0.00(-1.75,0.75)分,Z=-2.999,P=0.007.治疗眼泪膜破裂时间在第二次治疗后较基线增加(1.45±2.82)s,高于对照眼的(0.66±2.47)s,Z=-2.036,P=0.042.双眼SPEED问卷和角膜荧光染色评分在治疗后均降低,但同一随访点两组间评分变化值的差异无统计学意义.IPL治疗后无视力下降、眼压升高、眼内炎性反应等相关并发症.结论 IPL联合睑板腺按摩可提高MGD患者的睑板腺分泌功能、稳定泪膜、改善症状及眼表损伤.

abstractsObjective To explore short-term effect of intense pulsed light (IPL) combined with meibomian gland expression in treating meibomian gland dysfunction (MGD).Methods This study was a prospective,randomized,double-masked,controlled study.Forty-four MGD patients were enrolled in the study and received three consecutive IPL treatments with an interval of 4 weeks.One eye of each patient was randomly assigned as the study eye receiving the IPL therapy with an energy of 14-16 J/cm2,and the fellow eye was as the control eye receiving a placebo therapy with 0 J/cm2.Meibomian gland expression was immediately performed after the IPL treatment in both eyes.Efficacy was evaluated through assessment of the meibomian gland yielding secretion score (MGYSS),SPEED questionnaire,tear film break-up time (TBUT),cornea fluorescein staining and infrared meibography.Safety was evaluated through best spectacle corrected visual acuity,intraocular pressure,slit lamp examination and fundus examination.These examinations were performed before and after each treatment.Results Significant improvements were observed in the MGYSS and TBUT after IPL treatments (P＜0.05).The improvements compared to the baseline of MGYSS at the upper eyelid in the treatment eyes were significantly higher than those in the control eyes after the first treatment (Z=-2.036,P=0.003).The improvements compared to baseline of MGYSS at the lower eyelid and the TBUT in the treatment eyes were significantly higher than those in the control eyes after the second treatment (Z=-2.999 and-2.036,respectively P=0.007 and O.042,respectively).SPEED and cornea fluorescein staining were decreased in both eyes after IPL treatments,but there was no statistical difference between the two eyes.No obvious complication was observed in the study.Conclusions IPL treatment combined with meibomian gland expression is an efficient and safe therapy,and can increase meibomian gland yielding secretion,increase the TBUT,relieve the symptoms and repair the corneal epithelium defects for MGD eyes.