梅博米安腺体功能障碍治疗干眼症的强脉冲光
Summary
干眼症是一种越来越常见的疾病, 严重损害患者的生活质量。最近, 一种新的设备使用强脉冲光, 专门为眼周区域设计, 已被证明, 以改善泪膜稳定性和眼不适症状干眼症, 由于美波米腺功能障碍。
Abstract
干眼症 (DED) 是一种越来越常见的疾病, 也是患者最常见的投诉之一。绝大多数的 DED 是由所谓的 “蒸发” 亚型引起的, 主要是由 meibomian 腺体功能障碍 (MGD) 引起的。强脉冲光 (IPL) 器件采用波长范围广 (515-1200 nm) 的高强度多色光脉冲。IPL 治疗在皮肤科领域已经使用多年, 然后应用于眼科治疗 MGD。最近, 一种采用 IPL 的新设备是专门为眼周应用而设计的。该程序确定眼睑皮肤浅血管和毛细血管扩张的热选择性凝血和消融, 减少炎症介质和泪液细胞因子水平的释放, 并改善美波皮腺流出。IPL 治疗是无创的, 易于执行, 仅持续几分钟, 可以在办公室环境中进行。在本研究中, 19名患者接受了 3次 IPL 治疗。治疗后, 平均无创破碎时间和脂质层厚度等级均显著提高, 分别是由于泪膜稳定性和质量的提高。相反, 对于美波米腺损失和撕裂渗透性, 没有发现统计学上的显著变化。此外, 绝大多数接受治疗的患者 (17/19; 占总数的 99.5%) 认为他们的眼部不适症状在 IPL 治疗后有所改善。虽然 IPL 治疗提供了改善眼表参数和眼部不适症状后, 一个周期的三个疗程, 定期反复治疗, 以保持持久性, 在其有益的时间影响。
Introduction
干眼症 (DED) 是一种越来越常见的疾病, 也是临床去看眼科医生1 的最常见原因之一。受 DED 影响的患者所抱怨的主要症状不同于不同等级的发红和眼部不适, 以及慢性异物感觉、刺痛、灼烧、瘙痒、过度撕裂、疼痛、反复感染和短暂视觉干扰2。DED 对患者生活质量的影响与中度至重度心绞痛或透析治疗引起的影响被比较 3, 并与日常活动的限制和工作效率的丧失有关4。最近由 TFOS DEWS II 制定的干眼症定义突出了其多因素性质, 因为不同的复杂和异质性改变在疾病的发生和维持中发挥着重要作用2。
绝大多数干眼症是由所谓的 “蒸发性” 亚型引起的, 这种亚型主要是由 meibomian 腺功能障碍 (MGD) 引起的, 这种情况影响到世界特定地区多达70% 的人口5。梅博米安腺功能障碍是由位于上、下眼睑内的美波米安腺体的慢性改变引起的。本病的特点是腺体外管过度角化, 孔部阻塞不足, 功能不正常, 产生泪膜的外脂层, 导致撕裂不稳定 6, 7,8。
目前, 有几种不同的治疗策略, 旨在阻断干眼症的恶性循环, 主要包括抗生素、消炎药、眼睑卫生、温压和泪液9.然而, 这些疗法是慢性的, 往往只能提供部分或短期的症状缓解, 并伴随着随后的依从性问题。因此, 具有较高疗效和耐受性的新型治疗方法是可取的。近年来, 强脉冲光 (IPL) 治疗已被广泛用于皮肤病学治疗各种皮肤病, 如痤疮, 酒渣鼻, 毛细血管扩张和血管和色素病变 (如血管瘤, 静脉畸形,港酒污渍)10。当光线应用于皮肤时, 它被色素结构 (如血细胞和定位酶) 吸收, 随后产生的热量会凝固并破坏异常的血管11。近年来, 该技术在 FD 治疗的眼科领域得到了应用。有几种机制可以解释该程序的治疗效果。首先, IPL 治疗作用于诱导眼睑皮肤浅表血管和毛细血管扩张的热凝和选择性消融。此外, 该程序减少释放炎症介质和泪液细胞因子的水平, 这可能会促进压气腺末端导管 12,13的角化。其次, 将光能转化为热量, 导致美波米腺分泌物的升温和液化, 随后融化和流出减少了 11,14。最近, 其他机制, 如增强胶原蛋白合成和结缔组织重塑, 减少皮肤上皮细胞的周转, 以及调节细胞炎症标志物也被假设为15。
在这项研究中, 我们描述了最近商业化的 IPL 装置的使用和治疗效果, 该装置是专门为治疗 MGD 而开发的, 在这种装置中, IPL 的发射在多个校准和均质的多色序列中得到了 “调节”。顺序脉冲。因此, 本研究的目的是详细描述治疗过程, 以便将其传播到科学医学界, 使眼科医生有机会扩大目前用于 MGD 治疗的军备调查室。
Protocol
Representative Results
Discussion
强脉冲光器件采用氙气填充闪光灯, 在从可见光 (515 nm) 到红外 (1200 nm) 18 的宽波长光谱中产生多色非相干光的非激光高强度脉冲.光能脉冲由手机的头部通过蓝宝石或石英块释放, 因此直接应用于皮肤表面。
IPL 系统的作用机理是基于选择性热摩利的原理, 根据该原理, 某些目标, 称为色差, 能够吸收, 然后将光转化为热能12。
<p class="jove_conten…Disclosures
The authors have nothing to disclose.
Acknowledgements
提交人没有要声明的确认。
Materials
| I.C.P. Tearscope | SBM Sistemi, Turin, Italy | 1340864/R | Device for noninvasvive break-up time and lipid layer thickness evaluation |
| I.C.P. MGD | SBM Sistemi, Turin, Italy | 15006 | Device performing infrared meibomography and meibomian gland loss evaluation |
| TearLab Osmolarity System | TearLab Corporation, San Diego, CA, USA | 83861QW | Device for the measurement of tear osmolarity |
| E>Eye | E-Swin, Paris, France | Intense pulsed regulated light treatment device | |
| BM 900 Slit Lamp Biomioscropy | Haag-Streit, Koeniz, Switzerland | BM 900 | Slit Lamp Biomiscroscopy |
| Tobradex eye drops | Alcon Inc., Fort Worth, TX, USA | S01CA01 | Eye drops instilled immediately after the procedure in office |
References
- Schaumberg, D. A., Dana, R., Buring, J. E., Sullivan, D. A. Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies. Arch Ophthalmol. 127 (6), 763-768 (2009).
- Craig, J. P., et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 15 (3), 276-283 (2017).
- Buchholz, P., et al. Utility assessment to measure the impact of dry eye disease. Ocul Surf. 4 (3), 155-161 (2006).
- Uchino, M., et al. Dry eye disease and work productivity loss in visual display users: the Osaka study. Am J Ophthalmol. 157 (2), 294-300 (2014).
- Schaumberg, D. A., Nichols, J. J., Papas, E. B., Tong, L., Uchino, M., Nichols, K. K. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 52 (4), 1994-2005 (1994).
- Baudouin, C., et al. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol. 100 (3), 300-306 (2016).
- Knop, E., Knop, N., Millar, T., Obata, H., Sullivan, D. A. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci. 52 (4), 1938-1978 (1938).
- Bron, A. J., et al. TFOS DEWS II pathophysiology report. Ocul Surf. 15 (3), 438-510 (2017).
- Qiao, J., Yan, X. Emerging treatment options for meibomian gland dysfunction. Clin Ophthalmol. 7, 1797-1803 (2013).
- Papageorgiou, P., Clayton, W., Norwood, S., Chopra, S., Rustin, M. Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results. Br J Dermatol. 159 (3), 628-632 (2008).
- Toyos, R., McGill, W., Briscoe, D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 33 (1), 41-46 (2015).
- Vora, G. K., Gupta, P. K. Intense pulsed light therapy for the treatment of evaporative dry eye disease. Curr Opin Ophthalmol. 26 (4), 314-318 (2015).
- Liu, R., et al. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Am J Ophthalmol. 183, 81-90 (2017).
- Goldberg, D. J. Current Trends in Intense Pulsed Light. J Clin Aesthet Dermatol. 5 (6), 45-53 (2012).
- Dell, S. J. Intense pulsed light for evaporative dry eye disease. Clin Ophthalmol. 11, 1167-1173 (2017).
- Pult, H., Riede-Pult, B. H. Non-contact meibography: keep it simple but effective. Cont Lens Anterior Eye. 35 (2), 77-80 (2012).
- Fitzpatrick, T. B. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 124 (6), 869-871 (1988).
- Raulin, C., Greve, B., Grema, H. IPL technology: a review. Lasers Surg Med. 32 (2), 78-87 (2003).
- Toyos, R., Buffa, C. M., Youngerman, S. Case report: Dry-eye symptoms improve with intense pulsed light treatment. Eye World News Magazine. , (2005).
- Jiang, X., et al. Evaluation of the Safety and Effectiveness of Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction. J Ophthalmol. , (2016).
- Albietz, J. M., Schmid, K. L. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 101 (1), 23-33 (2018).
- Gupta, P. K., Vora, G. K., Matossian, C., Kim, M., Stinnett, S. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease. Can J Ophthalmol. 51 (4), 249-253 (2016).
- Dell, S. J., Gaster, R. N., Barbarino, S. C., Cunningham, D. N. Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction. Clin Ophthalmol. 11, 817-827 (2017).
- Vegunta, S., Patel, D., Shen, J. F. Combination Therapy of Intense Pulsed Light Therapy and Meibomian Gland Expression (IPL/MGX) Can Improve Dry Eye Symptoms and Meibomian Gland Function in Patients With Refractory Dry Eye: A Retrospective Analysis. Cornea. 35 (3), 318-322 (2016).
- Roy, N. S., Wei, Y., Kuklinski, E., Asbell, P. A. The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research. Invest Ophthalmol Vis Sci. 58 (6), BIO1-BIO19 (2016).
- Giannaccare, G., Vigo, L., Pellegrini, M., Sebastiani, S., Carones, F. Ocular Surface Workup With Automated Noninvasive Measurements for the Diagnosis of Meibomian Gland Dysfunction. Cornea. , (2018).
- Craig, J. P., Chen, Y. H., Turnbull, P. R. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 56 (3), 1965-1970 (1965).
- Meadows, J. F., Ramamoorthy, P., Nichols, J. J., Nichols, K. K. Development of the 4-3-2-1 meibum expressibility scale. Eye Contact Lens. 38 (2), 86-92 (2012).
- Finis, D., Hayajneh, J., König, C., Borrelli, M., Schrader, S., Geerling, G. Evaluation of an automated thermodynamic treatment (LipiFlow®) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial. Ocul Surf. 12 (2), 146-154 (2014).
- Yin, Y., Liu, N., Gong, L., Song, N. Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients. Curr Eye Res. 43 (3), 308-313 (2018).
- Guilloto Caballero, S., García Madrona, J. L., Colmenero Reina, E. Effect of pulsed laser light in patients with dry eye syndrome. Arch Soc Esp Oftalmol. 92 (11), 509-515 (2017).
