干眼个性化治疗临床观察
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Clinical observation on individualized therapy for dry eye
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    摘要:

    目的:对多种原因引起的干眼分别按照明显体征分类进行个性化治疗,评价其疗效和个性化治疗的意义。

    方法:采集门诊常见的多种原因引起的干眼140例,按照其突出体征分成三类。第一类:睑板腺功能障碍(meibomian gland dysfunction,MGD)的干眼60例,分成A1组(睑缘治疗组)和B1组(对照组)各30例; 第二类:角膜上皮损伤为主(角膜荧光染色FL评分≥5分)的干眼50例,分成A2组(戴角膜绷带镜组)和B2(对照组)各25例; 第三类:泪液低分泌(泪液分泌试验Schirmer Ⅰ≤5mm/5min)的干眼30例,分成A3组(泪小点栓塞组)和B3(对照组)各15例。前两类均运用1g/L艾氟龙眼液和1g/L玻璃酸钠眼液,其中A1组加睑缘清洗及口服强力霉素,A2组配戴角膜绷带接触镜治疗。第三类运用10g/L环孢霉素A眼液和卡波姆眼凝胶,其中A3组全部下泪小点栓塞后用药。随访2wk,记录三类个性治疗组(A1组、A2组、A3组)与相应对照组(B1组、B2组、B3组)治疗前和治疗2wk后的主观症状评分、角膜荧光染色(FL)评分、泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt)。采用t检验及配对t检验进行统计分析,比较各类中两组治疗前后及两组间以上指标的差异。

    结果:干眼140例个性治疗组(A1组、A2组、A3组)与相应对照组(B1组、B2组、B3 组)治疗前各项指标比较无差异。个性治疗组(A1 组、A2 组、A3组)与其治疗前、与相应对照组(B1组、B2组、B3组)治疗2wk后比较,在主观症状评分和BUT两个方面均有统计学差异。A3 组(泪小点栓塞组)治疗2wk后观察到下睑缘有明显泪河线形成,与治疗前、与B3 组(对照组)比较SⅠt均具有统计学差异。

    结论:干眼的治疗在去除病因同时,可针对主要体征,在抗炎和使用人工泪液的基础上,进行相应有效的个性化治疗,能快速缓解干眼症状,稳定泪膜。干眼个性化治疗具有重要意义。

    Abstract:

    AIM:To evaluate the efficacy of individualized therapy on dry eye induced by different reasons.

    METHODS: Totally 140 cases(140 eyes)of dry eye were divided into three categories according to eye symptoms. First category: 60 cases(60 eyes)with meibomian gland dysfunction(MGD)were divided into A1 group(palpebralis margin treatment group)and B1 group(control group); Second category: 50 cases(50 eyes)with corneal epithelium damage(corneal fluorescence staining FL Score≥5)were divided into A2 group(bandage contact lens group)and B2 group(control group); Third category: 30 cases(30 eyes)with low Schirmer test(Schirmer Ⅰ≤5mm)were divided into A3 group(lacrimal punctum plug group)and B3 group(control group). Both former categories treated by 1g/L fluorometholone eye drops and 1g/L hyaluronate sodium eye drops, but received limbus palpebralis cleaning, oral doxycycline in A1 group and bandage contact lens in A2 group else. The third category was treated by 10g/L cyclosporine A and carbomer eye gel, but lacrimal punctum plug in A3 group before received the drug treatment. Two weeks follow up, each case was examined by subjective symptom, cornea fluorescence colouration test, tear break-up time(BUT), and Schirmer test Ⅰ(SⅠt)in the treatment groups(A1,A2,A3)and the control groups(B1,B2,B3), the results pre- and post-treatment were compared. The t test was used for inferential statistics.

    RESULTS: There was no statistical difference between treatment groups(A1, A2, A3)and control groups(B1, B2, B3)before treatment. Two weeks after treatment, there was statistical difference between the treatment groups(A1, A2, A3)and control groups(B1, B2, B3)in subjective symptoms and BUT. The difference among A3 group(lacrimal punctum plug group, in which the lacrimal river line formed were observed 2 weeks after treatment)and B3 (control group)was statistically significant in SⅠt.

    CONCLUSION:On base of anti-inflammatory and use of artificial tears, individualized therapy is an effective and satisfactory clinical curative method in the treatment of dry eye.

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汤静,韩宇,蒲一民,等.干眼个性化治疗临床观察.国际眼科杂志, 2013,13(5):894-896.

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  • 收稿日期:2013-01-08
  • 最后修改日期:2013-04-27
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  • 在线发布日期: 2013-05-06
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