长期局部使用青光眼药物对睑板腺及泪膜的影响

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摘要目的：运用Keratograph眼表综合分析仪观察长期局部使用青光眼药物对睑板腺形态、功能及泪膜的影响。方法：收集单眼局部使用降眼压药物超过2年的青光眼患者42例42眼，使用青光眼药物的眼作为用药眼，对侧未使用青光眼药物眼作为对照眼，只使用1种降眼压药物的为单药组，使用2种以上降眼压药物的为多药组。Keratograph眼表综合分析仪记录首次泪膜破裂时间（NITBUTf）和平均泪膜破裂时间（NITBUTav），在红外光模式下拍摄上、下睑板腺形态图片并评分。裂隙灯显微镜下进行睑缘评分、睑板腺脂质评分、角膜荧光素染色评分。进行眼表疾病指数（OSDI）干眼问卷调查进行主观症状评分。结果：单药组和多药组睑缘异常评分、睑板腺形态及功能评分、角膜荧光素染色评分以及OSDI评分均较对照眼增高，NITBUTf和NITBUTav较对照眼缩短。多药组和单药组之间，睑缘异常评分、角膜荧光素染色、睑板腺形态及功能、OSDI评分差异无统计学意义，多药组NITBUTf和NITBUTav较单药组缩短。结论：长期局部使用青光眼药物对睑板腺形态和功能及泪膜均有影响，并加重干眼主观症状。

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	聂莉
	赵云娥
	李军花
	潘伟华
	窦仁慧
	赵银莹

关键词 ：青光眼, Keratograph, 眼表综合分析仪, 睑板腺, 泪膜

Abstract：Objective: To observe the effect of long-term topical anti-glaucoma medications on meibomian gland and tear film by means of Keratograph. Methods: This study included 42 glaucoma patients (42 eyes) treated with topical anti-glaucoma drugs in only one eye for more than 2 years. Untreated contralateral eyes served as the control group. The treated eyes were divided into two subgroups of multiple types anti-glaucoma eye drops group and single type group according to medication number. First noninvasive tear film break-up time (NITBUTf) and average noninvasive tear film break-up time (NITBUTav) were measured by Keratograph. Upper and lower eyelids were turned over to observe meibomian glands under infrared mode and then meibomian gland loss was scored. Lid margin, meibomian function and superficial punctate keratopathy (spk) were scored with a slit lamp. The subjective symptoms were estimated with ocular surface disease index (OSDI). Results: Treated eyes showed significantly higher scores for lid margin abnormality, spk score, OSDI score, meiboscore and meibum than that in the corresponding controls. Both NITBUTf and NITBUTav were significantly shorter in treated eyes than that in the control eyes. Subgroup analysis indicated a significantly shorter NITBUTf and NITBUTav in multiple types of anti-glaucoma eye drops group than that of the single type group. However, there was no significantly difference between the multiple drugs group and the single drug group in meiboscore, meibum, lid margin abnormality, spk score and OSDI score. Conclusion: Long-term anti-glaucoma eye drop usage affects not only meibomian gland morphology and function but also tear film, which increases the subjective symptoms of dry eye.

Key words： glaucoma Keratograph noninvasive ocular analyzer meibomian gland tear film

收稿日期: 2016-07-31

基金资助:温州市科技计划项目（Y20160463）；浙江省医药卫生科研基金资助项目（2017KY496）；浙江省省部共建计划（201647 538）。

通讯作者: 赵云娥，主任医师，硕士生导师，Email：zye@mail.eye.ac.cn。

作者简介: 聂莉（1981-），女，内蒙古锡盟人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I5/352

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