Effects of Different Frequency Intense Pulsed Light Treatment on Tear Film Stability and Meibomian Gland Function in Patients with Meibomian Gland Dysfunction
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摘要:
目的 分析不同频率强脉冲光（IPL）对睑板腺功能障碍（MGD）患者泪膜稳定性及睑板腺功能的影响。 方法 选取2021年3月至2021年12月玉溪市人民医院眼科收治的70例140眼MGD患者作为研究对象。按照数字表法随机将患者分为A组和B组，每组35例。A组在0周、第1周、第3周、第7周各进行1次IPL治疗（共治疗4次），B组在0周、第1周各进行1次IPL治疗（共治疗2次）。荧光素钠眼科检测试纸检测泪膜破裂时间。眼表综合分析仪测量平均非侵入性泪膜破裂时间（ NIBUTav）、首次非侵入性泪膜破裂时间（NIBUTf）、泪河高度和角膜荧光素染色。比较不同频率IPL治疗前后患者泪膜破裂时间、眼表疾病指数（OSDI）量表评分、NIBUTav、NIBUTf、泪河高度、睑板腺分泌能力评分、睑板腺分泌物评分以及角膜荧光素染色评分。 结果 与治疗前相比，A组和B组泪膜破裂时间和OSDI评分均明显降低，差异有统计学意义（P < 0.05）；A组泪膜破裂时间低于B组，差异有统计学意义（ P < 0.05），而A组和B组之间OSDI评分比较，差异无统计学意义（ P > 0.05）。治疗后，A组和B组患者NIBUTav、NIBUTf和泪河高度均明显升高，且A组NIBUTav、NIBUTf高于B组，而泪河高度低于B组，差异有统计学意义（ P < 0.05）。治疗后，A组和B组睑板腺分泌物状态评分、分泌能力评分均有所下降，且A组评分均低于B组，差异有统计学意义（ P < 0.05）；治疗后，A组和B组角膜荧光素染色评分均有所下降，且A组评分高于B组，差异有统计学意义（ P < 0.05）。 结论 采用在0周、第1周、第3周、第7周对MGD患者各进行1次IPL治疗，可有效改善患者干眼症状和体征，治疗期间可以很好地平衡疗效和安全性。 Abstract:Objective To analyze the effects of different frequency intense pulsed light （IPL）treatment on tear film stability and meibomian gland function in patients with MEibomian gland dysfunction （MGD）. Methods One hundred and forty eyes of 70 MGD patients admitted to Yuxi People’s Hospital from March 2021 to December 2021 were selected as the research objects. Patients were randomly divided into group A and group B according to the number table method, with 35 cases in each group. Group A received one IPL treatment at week 0, week 1, week 3 and week 7 （A total of 4 treatments）, and group B received one IPL treatment at week 0 and week 1 （A total of 2 treatments）.Fluorescein sodium ophthalmic dipstick was used to detect tear film rupture time. Mean non-invasive tear film rupture time （NIBUTav）, first non-invasive tear film rupture time （NIBUTf）, tear river height and corneal luciferin staining were measured by ocular surface analyzer. The tear film rupture time, OSDI scale score, NIBUTav, NIBUTf, lacrimal river height, meibomian gland secretion capacity score, meibomian gland secretion score and corneal fluorescein staining score were compared before and after IPL treatment at different frequencies. Results Compared with before treatment, the tear film rupture time and OSDI score in group A and GROUP B were significantly decreased, with statistical significance （P < 0.05）.The time of tear film rupture in group A was lower than that in group B, and the difference was statistically significant （ P < 0.05）, while the OSDI score between group A and GROUP B showed no significant difference （ P > 0.05）. After treatment, NIBUTav, NIBUTf and lacrimal river height were significantly increased in group A and group B, and NIBUTav and NIBUTf in group A were higher than those in group B, while the lacrimal river height was lower than those in group B, with statistical significance （ P < 0.05）.After treatment, meibomian gland secretion status score and secretory ability score of group A and GROUP B were decreased, and the score of group A was lower than that of group B, the difference was statistically significant （ P < 0.05）. After treatment, the corneal fluorescein staining score of group A and group B decreased, and the score of group A was higher than that of group B, the difference was statistically significant （ P < 0.05）. Conclusion IPL treatment at week 0, week 1, week 3 and week 7 for MGD patients can effectively improve the symptoms and signs of dry eye, and the efficacy and safety can be well balanced during the treatment. -
表 1 比较不同频率IPL治疗前后MGD患者泪膜破裂时间和OSDI评分（ $\bar x \pm s $）
Table 1. Comparison of tear film rupture time and OSDI score of MGD patients before and after IPL treatment at different frequencies（ $\bar x \pm s $）
组别 n 泪膜破裂时间（d） t P OSDI评分（分） t P 治疗前 治疗后 治疗前 治疗后 A组 35 69.12 ± 8.05 16.78 ± 3.85 34.701 < 0.001* 23.31 ± 4.56 9.32 ± 3.04 15.102 < 0.001* B组 35 68.87 ± 7.92 28.52 ± 5.12 25.312 < 0.001* 23.18 ± 4.47 9.24 ± 2.81 15.619 < 0.001* t 0.131 10.842 0.120 0.114 P 0.896 < 0.001* 0.905 0.909 *P < 0.05。 
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表 2 比较不同频率IPL治疗前后MGD患者眼表临床数据（n = 35， $\bar x \pm s $）
Table 2. Comparison of ocular surface clinical data of MGD patients before and after IPL treatment at different frequencies （n = 35， $\bar x \pm s $）
组别 NIBUTav（s） t P NIBUTf（s） t P 泪河高度（mm） t P 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 7.98 ± 2.14 12.57 ± 3.21 7.039 < 0.001* 6.08 ± 1.77 9.46 ± 2.14 7.200 < 0.001* 0.18 ± 0.03 0.20 ± 0.02 3.282 0.002* B组 7.86 ± 2.05 11.06 ± 2.86 5.380 < 0.001* 5.94 ± 1.68 8.11 ± 1.89 5.077 < 0.001* 0.17 ± 0.02 0.22 ± 0.04 6.614 < 0.001* t 0.239 2.078 0.339 2.797 1.641 2.646 P 0.811 0.042* 0.735 0.007* 0.106 0.010* *P < 0.05。
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表 3 比较不同频率IPL治疗前后MGD患者睑板腺分泌能力和睑板腺分泌物状态评分（ $\bar x \pm s $）
Table 3. Comparison of meibomian gland secretion capacity and meibomian gland secretion status scores of MGD patients before and after IPL treatment at different frequencies （ $\bar x \pm s $）
组别 n 睑板腺分泌能力评分（分） t P 睑板腺分泌物状态评分（分） t P 治疗前 治疗后 治疗前 治疗后 A组 35 17.52 ± 3.21 5.86 ± 1.32 19.874 < 0.001* 14.89 ± 3.05 5.48 ± 1.18 17.023 < 0.001* B组 35 17.36 ± 3.13 12.34 ± 2.42 7.506 < 0.001* 14.75 ± 2.86 8.64 ± 2.17 10.069 < 0.001* t 0.211 13.907 0.198 7.569 P 0.833 < 0.001* 0.844 < 0.001* *P < 0.05。
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表 4 不同频率IPL治疗前后MGD患者角膜荧光素染色情况比较（ $\bar x \pm s $）
Table 4. Comparison of corneal luciferin staining of MGD patients before and after IPL treatment at different frequencies （ $\bar x \pm s $）
组别 n 角膜荧光素染色评分（分） t P 治疗前 治疗后 A组 35 3.25 ± 0.35 2.21 ± 0.23 14.691 < 0.001* B组 35 3.17 ± 0.29 2.08 ± 0.21 18.010 < 0.001* t 0.225 2.469 P 0.823 0.016* *P < 0.05。
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