强脉冲激光联合睑板腺按摩治疗2型糖尿病合并MGD相关干眼的临床效果观察

Clinical Effect of Intense Pulsed Laser Combined with Meibomian Gland Massage in the Treatment of Type 2 Diabetes Mellitus with MGD-Related Dry Eye

摘要: 目的：评价强脉冲激光(IPL)治疗2型糖尿病合并睑板腺功能障碍(MGD)相关干眼的临床效果。方法：前瞻性选取2022.01~2022.10于我院眼科就诊的2型糖尿病合并MGD干眼症患者，根据随机数字表法分为试验组和对照组，试验组采用IPL联合睑板腺按摩治疗，对照组采用睑板腺按摩治疗，每4次治疗为一个疗程。比较两组治疗前及末次治疗后1月、2月的眼表疾病指数量表评分(OSDI)、睑板腺分泌功能评分(MGYSS)、泪河高度(TMH)、首次非侵入性泪膜破裂时间(NIBUTf)、角膜荧光素染色(CFS)。结果：两组患者OSDI、MGYSS、TMH、NIBUTf、CFS基线水平无统计学差异(P > 0.05)。两组治疗后OSDI评分均下降，治疗后2月试验组OSDI评分显著低于对照组(P = 0.015)。两组治疗后MGYSS评分明显上升，治疗后1月、2月，试验组明显高于对照组(P = 0.036; P < 0.001)。治疗后1月、2月，试验组TMH较基线水平改善(P < 0.001; P < 0.001)。两组治疗后NIBUTf都较治疗前升高，治疗后2月试验组NIBUTf明显高于对照组(P = 0.03)。试验组治疗后CFS评分较基线水平明显下降(P < 0.05)，治疗后2月，试验组较对照组下降，差异具有统计学意义(P = 0.001)。结论：IPL联合睑板腺按摩治疗能有效减轻2型糖尿病合并MGD相关干眼患者的临床症状，改善睑板腺功能和眼表情况。

Abstract: Objective: To evaluate the clinical effect of intense pulsed light (IPL) in the treatment of type 2 dia-betic mellitus with meibomian gland dysfunction (MGD) related dry eye. Methods: A prospective study was conducted to select patients with type 2 diabetes mellitus and MGD-related dry eye who were treated in ophthalmology department of our hospital from January, 2022 to October, 2022. They were randomly divided into two groups: IPL combined with meibomian gland massage treat-ment group and meibomian gland massage treatment group. Every 4 treatments is a course of treatment. Before treatment and 1 month and 2 months after the last treatment, the ocular surface disease index (OSDI) score, meibomian gland yielding secretion score (MGYSS), tear meniscus height (TMH), first noninvasive tear break-up time (NIBUTf), and corneal fluorescein staining (CFS) were recorded. Results: There were no significant differences in the baseline levels of OSDI, MGYSS, TMH, NIBUTf and CFS between the two groups (P > 0.05). The OSDI scores of the two groups de-creased after treatment, and the OSDI score of the experimental group was significantly lower than that of the control group at 2 months after treatment (P = 0.015). The MGYSS score of the two groups increased significantly after treatment, and in the 1 and 2 months after treatment, the ex-perimental group was significantly higher than the control group (P = 0.036; P < 0.001). In the 1 and 2 months after treatment, TMH in the experimental group was improved compared with the baseline level (P < 0.001; P < 0.001). The NIBUTf of the two groups after treatment was higher than that before treatment, and the NIBUTf of the experimental group was significantly higher than that of the control group at 2 months after treatment (P = 0.03). Compared with the baseline value, the CFS score of the experimental group after treatment significantly decreased (P < 0.05). In the 2 months after treatment, the experimental group decreased compared with the control group (P = 0.001). Conclusion: IPL combined with meibomian gland massage treatment can effectively reduce the clinical symptoms of type 2 diabetes mellitus with MGD-related dry eye patients, improve mei-bomian gland function and ocular surface condition.