Godin Morgan R, Stinnett Sandra S, Gupta Preeya K
Department of Ophthalmology, Division of Cornea and Refractive Surgery, Duke University Eye Center Durham, NC.
Cornea. 2018 Sep;37(9):1155-1158. doi: 10.1097/ICO.0000000000001621.
To evaluate the clinical outcomes of thermal pulsation treatment in patients with meibomian gland dysfunction (MGD) and dry eye secondary to Sjogren disease.
Twenty-four eyes from 13 patients with previously diagnosed Sjogren disease who presented to our institution with dry eye symptoms and had thermal pulsation treatment were prospectively followed up. Patients underwent comprehensive slit-lamp examination, including MGD grading, gland oil flow, corneal and conjunctival staining scores, and tear break-up time (TBUT). Tear osmolarity was tested before and after treatment.
The average patient age was 62.4 years (range, 31-78 yrs); 12 were women and 1 a man. The average meibomian gland oil flow score showed an increase from pretreatment 0.71 to 1.75 at 1 year posttreatment (range 9-15 months) (P = 0.001). The average corneal staining score decreased from a pretreatment grade of 1.04 to a posttreatment grade of 0.36 (P < 0.001). The average conjunctival staining score decreased from a pretreatment grade of 1.5 to a posttreatment grade of 0.48 (P < 0.001). The average tear break-up time improved from 3.8 seconds before treatment to 7.5 seconds after thermal pulsation treatment (P < 0.001). There was no statistically significant change in the tear osmolarity or Ocular Surface Disease Index score.
Our findings suggest that MGD is an important contributor to dry eye disease in patients with Sjogren disease and should not be overlooked when considering treatment options. Thermal pulsation is a therapeutic option for patients with Sjogren disease who have MGD and dry eye symptoms. After a single treatment, patients exhibited increased oil flow and tear break-up time with an associated decrease in corneal and conjunctival staining.
评估热脉动治疗在患有睑板腺功能障碍（MGD）和干燥综合征继发干眼症患者中的临床疗效。
对13例先前诊断为干燥综合征且因干眼症状前来我院接受热脉动治疗的患者的24只眼睛进行前瞻性随访。患者接受了全面的裂隙灯检查，包括MGD分级、睑板腺油脂分泌量、角膜和结膜染色评分以及泪膜破裂时间（TBUT）。在治疗前后检测泪液渗透压。
患者平均年龄为62.4岁（范围31 - 78岁）；12例为女性，1例为男性。睑板腺油脂分泌量平均评分从治疗前的0.71增加至治疗后1年（9 - 15个月）的1.75（P = 0.001）。角膜染色平均评分从治疗前的1.04级降至治疗后的0.36级（P < 0.001）。结膜染色平均评分从治疗前的1.5级降至治疗后的0.48级（P < 0.001）。泪膜破裂时间从治疗前的3.8秒改善至热脉动治疗后的7.5秒（P < 0.001）。泪液渗透压或眼表疾病指数评分无统计学显著变化。
我们的研究结果表明，MGD是干燥综合征患者干眼症的重要病因，在考虑治疗方案时不应被忽视。热脉动是患有MGD和干眼症状的干燥综合征患者的一种治疗选择。单次治疗后，患者睑板腺油脂分泌量增加，泪膜破裂时间延长，同时角膜和结膜染色减轻。
