白内障术前行 Lipiflow 治疗的效果：一项前瞻性、随机、对照研究。
Effects of Lipiflow Treatment Prior to Cataract Surgery: A Prospective, Randomized, Controlled Study.
机构信息
From the Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (J.P., Y.-S.Y., K.S., G.H., D.H.L., T.-Y.C.), Department of Ophthalmology, Dongguk University Gyeongju Hospital, Dongguk University School of Medicine, Gyeongju, Gyeongsangbuk-do (J.P.), Department of Ophthalmology, Uijeongbu St. Mary's Hospital, the Catholic University of Korea, Uijeongbu-si (Y.-S.Y.), Department of Ophthalmology, Seongnam Citizens Medical Center, Seongnam-si, Gyeonggi-do, Republic of Korea (K.S.), Department of Ophthalmology, Itoh Clinic, Saitama, Japan (R.A.), and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (D.H.L.).
From the Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (J.P., Y.-S.Y., K.S., G.H., D.H.L., T.-Y.C.), Department of Ophthalmology, Dongguk University Gyeongju Hospital, Dongguk University School of Medicine, Gyeongju, Gyeongsangbuk-do (J.P.), Department of Ophthalmology, Uijeongbu St. Mary's Hospital, the Catholic University of Korea, Uijeongbu-si (Y.-S.Y.), Department of Ophthalmology, Seongnam Citizens Medical Center, Seongnam-si, Gyeonggi-do, Republic of Korea (K.S.), Department of Ophthalmology, Itoh Clinic, Saitama, Japan (R.A.), and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (D.H.L.).
出版信息
Am J Ophthalmol. 2021 Oct;230:264-275. doi: 10.1016/j.ajo.2021.04.031. Epub 2021 May 13.
UNLABELLED
To investigate the effects of preoperative Lipiflow (Johnson & Johnson, Jacksonville, FL, USA) treatment before cataract surgery on meibomian gland dysfunction (MGD) and dry eye induced by surgery.
DESIGN
Prospective, randomized controlled study.
METHODS
This study comprised 124 eyes of 124 patients with planned surgery for senile cataract. Participants were randomly allocated into control and Lipiflow groups based on administration of Lipiflow treatment 3 weeks before cataract surgery. For meibomian gland (MG) evaluation, MG atrophy, degree of gland expressibility, and quality of gland secretions were examined at the baseline visit and 1 and 3 months postoperatively. Ocular surface parameters of tear film break-up time, Oxford corneal staining score, and tear film lipid layer thickness were measured at each visit. Ocular Surface Disease Index and Dry Eye Questionnaire were also assessed.
RESULTS
The control group exhibited a significant decrease in MG expressibility, worsened meibum quality, decreased lipid layer thickness, and worsened corneal staining after cataract surgery. Also, dry eye symptom showed significant worsening. Conversely, the Lipiflow group showed significantly improved MG patency and meibum quality, increased tear film break-up time, and reduced corneal staining, and presented improved subjective outcomes reported on both Ocular Surface Disease Index and Dry Eye Questionnaire. The improvement of each parameter in the Lipiflow group showed a linear correlation with baseline MGD grade. In addition, patients without baseline MGD showed less worsening or improvement of MGD and dry eye induced by surgery, with preoperative Lipiflow treatment.
CONCLUSIONS
Preoperative Lipiflow treatment conducted before cataract surgery may be a safe and effective intervention for relieving MGD and dry eye induced by surgery. It might be recommended not only for the patients with preoperative MGD but also for those without baseline MGD, to prevent the development of MGD and dry eye induced by ocular surgeries.
目的
研究白内障术前使用 Lipiflow（强生公司，美国杰克逊维尔）治疗对手术引起的睑板腺功能障碍（MGD）和干眼的影响。
设计
前瞻性、随机对照研究。
方法
本研究纳入了 124 例计划接受老年性白内障手术的患者的 124 只眼。根据白内障术前 3 周是否行 Lipiflow 治疗，将患者随机分为对照组和 Lipiflow 组。采用睑板腺评估、MG 萎缩、腺体分泌质量和泪膜破裂时间等指标评估泪膜稳定性；采用牛津角膜染色评分和泪膜脂质层厚度评估泪膜质量。分别在术前、术后 1 个月和 3 个月时进行检查。同时评估眼表疾病指数和干眼问卷。
结果
对照组在白内障手术后，MG 分泌能力显著下降，泪膜脂质层厚度变薄，角膜染色评分增加，干眼症状明显恶化。相反，Lipiflow 组的 MGD 明显改善，MG 通畅性和泪膜脂质层厚度增加，泪膜破裂时间延长，角膜染色评分降低，眼表疾病指数和干眼问卷的主观评分均明显改善。泪膜脂质层厚度、泪膜破裂时间和角膜染色评分的改善与术前 MGD 严重程度呈线性相关。此外，无基线 MGD 的患者术前行 Lipiflow 治疗后，手术引起的 MGD 和干眼的恶化或改善程度较小。
结论
白内障术前使用 Lipiflow 治疗可能是一种安全有效的缓解手术引起的 MGD 和干眼的方法。建议不仅对术前有 MGD 的患者，而且对无基线 MGD 的患者，也可在术前使用 Lipiflow 治疗，以预防眼部手术引起的 MGD 和干眼。
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