Arroyo-Del Arroyo Cristina, Fernández Itziar, Novo-Diez Andrea, Blanco-Vázquez Marta, López-Miguel Alberto, González-García María Jesús
Ocular Surface Group, Instituto Universitario de Oftalmobiología Aplicada (IOBA) (C.A.-d.A., I.F., A.N.-D., M.B.-V., A.L.-M., M.J.G.-G.), Universidad de Valladolid, Valladolid, Spain; Departamento de Física Teórica (C.A.-d.A., A.N.-D., M.J.G.-G.), Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain; Networking Research Center on Bioengineering (I.F., M.J.G.-G.), Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain; and Redes Temáticas de Investigación Cooperativa en Salud (Oftared) (A.L.-M.), Instituto de Salud Carlos III, Madrid, Spain.
Eye Contact Lens. 2021 May 1;47(5):256-264. doi: 10.1097/ICL.0000000000000727.
To assess the consecutive implementation of habitual contact lens discomfort (CLD) management strategies: lid hygiene, daily disposable CL (DDCL) fitting, and artificial tear (AT) supplementation.
Contact lens (CL) wearers with CLD symptoms (CLDEQ-8 ≥12 points) were included in the study. Subjects with Meibomian gland dysfunction (MGD) were instructed to perform lid hygiene. All participants were fitted with a DDCL (delefilcon A) and evaluated 1 month later. After, half of them were randomly assigned to use AT (Povidone-2%) at least three times/day, and all participants were evaluated 1 month later. Tests performed were: lower tear meniscus area (LTMA), bulbar, limbal, and tarsal hyperemia, noninvasive tear break-up time (NITBUT), and corneal and conjunctival staining. Weighted combined clinical scores (CS) were created to analyze signs. Changes in symptoms (CLDEQ-8) and CS were analyzed using linear mixed models.
Forty-two subjects (mean age: 23.2±4.9 years) completed the study. Two CS were created, CS 1 was composed of bulbar, limbal, and tarsal hyperemia and corneal staining, and CS 2 by NITBUT, LTMA, and conjunctival staining. CLDEQ-8 was reduced after lid hygiene (mean: -2.73±2.13; P=0.012) and DDCL use (mean: -10.1±3.54; P<0.01), but not after AT use (P=0.62). CS 1 did not change after any intervention. CS-2 was higher (P=0.04) in DGM subjects after lid hygiene, it decreased (P=0.04) after DDCL use.
Lid hygiene is effective for reducing CLD symptoms in MGD patients. Refitting subjects with delefilcon A is an effective intervention for CLD to reduce symptoms and achieve a healthier ocular surface. Simultaneous administration of AT did not further improve CLD.
评估习惯性隐形眼镜不适（CLD）管理策略的连续实施情况：睑缘卫生、每日更换型隐形眼镜（DDCL）验配和人工泪液（AT）补充。
有CLD症状（CLDEQ-8≥12分）的隐形眼镜佩戴者纳入本研究。睑板腺功能障碍（MGD）患者接受睑缘卫生指导。所有参与者验配一副DDCL（delefilcon A），1个月后进行评估。之后，其中一半被随机分配至每天至少使用3次AT（2%聚维酮），所有参与者1个月后再次评估。所进行的检测项目有：下方泪河面积（LTMA）、球结膜、角膜缘和睑结膜充血、非侵入性泪膜破裂时间（NITBUT）以及角膜和结膜染色。创建加权综合临床评分（CS）以分析体征。使用线性混合模型分析症状（CLDEQ-8）和CS的变化。
42名受试者（平均年龄：23.2±4.9岁）完成研究。创建了两个CS，CS 1由球结膜、角膜缘和睑结膜充血以及角膜染色组成，CS 2由NITBUT、LTMA和结膜染色组成。睑缘卫生后CLDEQ-8降低（均值：-2.73±2.13；P=0.012），使用DDCL后降低（均值：-10.1±3.54；P<0.01），但使用AT后未降低（P=0.62）。任何干预后CS 1均未改变。MGD受试者睑缘卫生后CS-2更高（P=0.04），使用DDCL后降低（P=0.04）。
睑缘卫生对减轻MGD患者的CLD症状有效。为受试者重新验配delefilcon A是减轻CLD症状并实现更健康眼表的有效干预措施。同时使用AT并未进一步改善CLD。
