目的 评价强脉冲光(IPL)治疗睑板腺功能障碍(MGD)相关性干眼的有效性与安全性。方法 检索PubMed、EMbase、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)。收集IPL治疗MGD相关性干眼的临床随机对照试验(RCT)。对纳入的文献质量评价,选取所需数据,以循证医学软件RevMan 5.4做meta分析。结果 共纳入11个RCT。在3个月随访中,与睑板腺按摩(MGX)组比较,IPL联合MGX组能明显提高泪液分泌量而降低眼表疾病指数评分,在角膜荧光素染色及泪液河高度方面没有统计学差异;与假治疗组比较,IPL可提高睑板腺排出能力、改善睑板腺的缺失及睑板腺分泌物性状,但在角膜荧光素染色方面没有统计学差异。在6个月随访中,与MGX组比较,IPL联合MGX组睑板腺分泌功能明显改善,但在泪液分泌量方面没有统计学差异;与假治疗组比较,IPL能明显提高泪膜破裂时间及降低眼表疾病指数评分。在8个月随访中,IPL联合MGX组明显提高了泪膜破裂时间、角膜损伤得到改善,但在睑板腺缺失及泪液分泌量方面没有统计学差异。在9个月随访中,联合治疗在泪膜破裂时间、角膜荧光素染色、睑板腺分泌功能评分方面均没有统计学差异。在整个随访期间标准干眼症状评估问卷评分表现不稳定。现有资料未提示严重不良反应。结论 IPL联合MGX或单纯IPL治疗在较长期内能有效改善MGD相关性干眼的大部分体征及症状,在9个月后疗效基本减退。
Abstract
Objective To evaluate the efficacy and safety of intense pulsed light(IPL) therapy for dry eye associated with meibomian gland dysfunction(MGD). Methods A computerized search was conducted in the Cochrane Library, Pubmed, Embase, CNKI, CBM, and VIP database to collect clinical randomized controlled trails (RCTs) investigating IPL for MGD-associated dry eye.The quality of the included studies was assessed, and meta-analysis was conducted using RevMan 5.4 software. Results A total of 11 RCTs were included. During the 3-month follow-up, compared with the meibomian gland expression(MGX) group, the IPL combined with MGX group significantly increased schirmer and reduced the ocular surface disease index scores, althought no statistical differences were observed in corneal fluorescein staining and tear meniscus height. Compared with the sham treatment group, IPL significantly improved meibomian gland expressibility and meiboscore and meibomian gland quality, but no statistical difference was noted in corneal fluorescein staining. During the 6-month follow-up, compared with the MGX group, the IPL combined with MGX group showed significant improvement in meibomian gland yielding secretion score, but no statistical difference was found in schirmer. Compared with the sham treatment group, IPL significantly prolonged tear break-up time and reduced the ocular surface disease index scores. During the 8-month follow-up, the IPL combined with MGX group significantly increased the tear break-up time and improved corneal fiuorescein staining, althought no significant difference was found in meiboscore and schirmer. At 9-month follow-up, there were no statistically significant differences in tear break-up time, corneal fiuorescein staining, meibomian gland yielding secretion score in the combined treatment group. The standard patient evaluation of eye dryness questionnaire scores showed instability during this period. No serious adverse events were reported in the available data. Conclusions IPL combined with MGX or IPL alone can effectively improve most signs and symptoms of MGD-associated dry eye over a longer period,but the therapeutic effect gradually decreases after 9 months.
关键词
强脉冲光 /
睑板腺功能障碍 /
随机对照试验 /
meta分析 /
干眼
Key words
intense pulsed light /
meibomian gland dysfunction /
randomized controlled trial /
meta-analysis /
dry eye
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