CAJ | 학술논문

目的评估硅胶泪点塞治疗泪液缺乏型干眼的临床疗效.方法前瞻性研究.采用硅胶泪点塞(法国FCI公司)治疗65例(65只眼)药物治疗不理想的泪液缺乏型干眼患者,分别于治疗前及治疗后6周、6个月记录人工泪液使用次数,并行眼表疾病指数(OSDI)评分、裂隙灯显微镜检查、角膜荧光素染色评分、泪膜破裂时问(BUT)及基础泪液分泌试验(SIt),以观察临床疗效.患者治疗前与治疗后的OSDI得分、SIt结果、BUT均采用重复测量设计资料的方差分析,人工泪液使用次数、结膜充血情况及角膜荧光素染色评分均采用多个独立样本两两比较的Nemenyi检验.结果治疗后6个月,57只眼(87.69％)干眼症状明显缓解,人工泪液使用次数减少,25只眼(38.46％)症状消失,无需使用人工泪液.治疗前、治疗后6周、治疗后6个月患者OSDI平均分值分别为37.32±2.41、19.60±8.07及18.17±7.93,SIt结果平均值分别为(3.03±0.75)、(6.66±2.10)及(6.75±2.16)mm,BUT平均值分别为(2.91±0.76)、(7.02±2.39)及(7.57±2.38)s,3种评价指标治疗前后差异均有统计学意义(F=344.10,169.59,2542.00;P＜0.01).结膜充血情况及角膜荧光素染色评分较治疗前均明显改善.在本研究中主要的并发症为异物感、部分性泪点塞脱出、晨起溢泪及完全性泪点塞脱出.结论使用硅胶泪点塞治疗泪液缺乏型干眼稳定、安全、有效.
목적 평고규효루점새치료루액결핍형간안적림상료효.방법 전첨성연구.채용규효루점새(법국FCI공사)치료65례(65지안)약물치료불이상적루액결핍형간안환자,분별우치료전급치료후6주、6개월기록인공루액사용차수,병행안표질병지수(OSDI)평분、렬극등현미경검사、각막형광소염색평분、루막파렬시문(BUT)급기출루액분비시험(SIt),이관찰림상료효.환자치료전여치료후적OSDI득분、SIt결과、BUT균채용중복측량설계자료적방차분석,인공루액사용차수、결막충혈정황급각막형광소염색평분균채용다개독립양본량량비교적Nemenyi검험.결과 치료후6개월,57지안(87.69％)간안증상명현완해,인공루액사용차수감소,25지안(38.46％)증상소실,무수사용인공루액.치료전、치료후6주、치료후6개월환자OSDI평균분치분별위37.32±2.41、19.60±8.07급18.17±7.93,SIt결과평균치분별위(3.03±0.75)、(6.66±2.10)급(6.75±2.16)mm,BUT평균치분별위(2.91±0.76)、(7.02±2.39)급(7.57±2.38)s,3충평개지표치료전후차이균유통계학의의(F=344.10,169.59,2542.00;P＜0.01).결막충혈정황급각막형광소염색평분교치료전균명현개선.재본연구중주요적병발증위이물감、부분성루점새탈출、신기일루급완전성루점새탈출.결론 사용규효루점새치료루액결핍형간안은정、안전、유효.
Objective To evaluate the efficacy of silicone punctual plug for treating aqueous tear deficiency dry eye patients.Methods Prospective consecutive cases study.Silicone punctal plugs (France Chirurgie Instrumentation) were inserted into lower canaliculus in 65 tear deficiency dry eye patients (65 eyes).The clinical data collected included sex and age of the patients,frequency of lubricant use,the Ocular Surface Disease Index (OSDI) scores,slit lamp microscope examination,Schirmer I test (SIT)(with anesthesia),tear break-up time (TBUT),and ocular surface staining with fluoresce in sodium.All examinations were recorded at baseline,6 weeks and 6 months after punctal occlusion.Results There were 41 women and 24 men in this study,and their average age was 41.77 years old.The dry eye symptoms improved in 57 (87.69％) of 65 eyes at 6 months follow-up.The frequency of lubricant use was significantly decreased in these eyes (x2 =81.97,P ＜ 0.01).More importantly,the symptoms disappeared in 25 (38.46％) eyes,which did not need lubricant any more.At baseline,6 weeks and 6 months after punctal occlusion,OSDI mean score was 37.32 ± 2.41,19.60 ± 8.07 and 18.17 ± 7.93,respectively (F =344.10,P ＜ O.01) ; mean SIT result was (3.03 ± 0.75) mm,(6.66 ± 2.10) mm and (6.75 ± 2.16) mm,respectively (F =169.59,P ＜ 0.O1) ; mean TBUT was (2.91 ± 0.76) s,(7.02 ± 2.39) s and (7.57 ± 2.38) s,respectively (F =242.00,P ＜ 0.01).Compared with the baseline data,hyperemia of conjunctiva grading and ocular surface staining scores were also improved significantly after plug insertion,and all of these differences were statistically significant.Foreign body sensation was the most common complication in our study (12 eyes,18.46％).Epiphora (4 eyes,6.15％),partial extrusion (3 eyes,4.62％),and total extrusion (3 eyes,4.62％) were the other complications encountered.Conclusion Silicone punctal plug insertion is a stable,effective and safety method for the treatment of tear deficiency dry eve.