摘要
目的了解具有顽固症状的轻中度干眼患者的双眼调节集合功能及相关干预对此类患者主观症状的影响。方法纳入2017年12月至2019年6月于中山大学中山眼科中心就诊的103例轻中度干眼患者,经过3个月的常规治疗后,眼表疾病指数(OSDI)下降≥12.5分为症状改善组,其余为顽固症状组。评估所有患者双眼调节集合功能、OSDI、泪膜破裂时间(TBUT)、泪液分泌试验(ST)、角膜荧光素染色(FL)。顽固症状组患者在常规干眼治疗的基础上加用针对调节集合功能异常的矫正干预,8周后再次复查上述指标。比较顽固症状组、症状改善组中双眼调节集合功能异常的发生率及顽固症状组治疗前后双眼调节集合功能、OSDI及泪膜稳定性的变化。结果103例干眼患者中,43例常规治疗有效为症状改善组,男18例,女25例,年龄(27±6)岁;60例常规治疗后效果不佳为顽固症状组,男32例,女28例,年龄(30±6)岁。顽固症状组双眼调节集合功能异常的发生率明显高于症状改善组(100%比72.1%,P<0.001)。40例顽固症状者在评估双眼调节集合功能后,增加针对双眼调节集合功能异常的相关矫正干预8周。8周后OSDI较前明显下降[(23.4±16.0)比(40.6±15.7)分,P<0.001],但ST、TBUT、FL未见明显改善(均P>0.05)。结论双眼调节集合功能异常在常规治疗效果不佳的干眼患者中发生率很高,对调节集合功能进行干预可改善这些患者的主观症状。
Objective To investigate the accommodation and vergence(AV)function of patients with mild to moderate refractory dry eye symptoms,and determine the impact of relevant interventions on subjective symptoms.Methods A total of 103 patients with dry eye disease(DED)in Zhongshan Ophthalmic Center between December 2017 and June 2019 were included.After 3-month conventional treatment,the patients entered the treatment-responsive group if ocular surface disease index(OSDI)decreased≥12.5,and others were recruited into the refractory symptoms group.Binocular AV function,OSDI,tear break-up time(TBUT),Schirmer′s test(ST)and fluorescein staining(FL)were determined in all the patients.Corrective therapy on the AV dysfunction was added in the refractory symptoms group besides the conventional therapy.The above-mentioned indexes were reexamined 8 weeks later.The incidence of AV dysfunction was compared between the refractory symptoms group and the treatment-responsive group.Moreover,the differences of OSDI and tear film stability were compared before and after the corrective therapy in the refractory symptoms group.Results Sixty of 103 DED patients were classified into the refractory symptoms group[mean age:(27±6)years;18 males and 25 females]and 43 into the treatment-responsive group[mean age:(30±6)years;32 males and 28 females].The incidence of AV dysfunction in the refractory symptom group(100%)was higher than that of the treatment responsive group(72.1%)(P<0.001).Forty patients with refractory symptoms accomplished the 8-week corrective therapy,and the OSDI score was significant improved(23.4±16.0 vs 40.6±15.7,P<0.001).However,further changes in ST,TBUT and FL were not detected in these patients(all P>0.05).Conclusions There is a high prevalence of AV dysfunction in patients with refractory symptomatic DED.The corrective therapy on AV may improve the subjective symptoms in these patients.
作者
李晶
叶青青
罗晓慧
陈志鹏
张胜蓝
李劲嵘
梁凌毅
刘祖国
Li Jing;Ye Qingqing;Luo Xiaohui;Chen Zhipeng;Zhang Shenglan;Li Jinrong;Liang Lingyi;Liu Zuguo(Zhongshan Ophthalmic Center,Sun Yat-sen University,State Key Laboratory of Ophthalmology,Guangzhou 510060,China;Department of Ophthalmology,Xiang'an Hospital and Xiamen Eye Center Affiliated to Xiamen University,Eye Institute of Xiamen University,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science,Fujian Engineering and Research Center of Eye Regenerative Medicine,Xiamen 361102,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第32期2519-2524,共6页
National Medical Journal of China
基金
国家自然科学基金(81770892,81770954)
广东省自然科学基金(2019A1515012012)
高水平医院建设项目(303020101)。
关键词
干眼综合征
调节
集合
Dry eye syndromes
Accommodation
Vergence
