睑板腺功能障碍(meibomian gland dysfunction，MGD)是眼科常见疾病，是蒸发过强型干眼的主要原因。基于人群流行病学的调查显示：MGD亚洲的发病率为46.2%~69.3%。目前，MGD治疗的方式包括眼睑清洁、热敷、睑板腺按摩、人工泪液、抗生素等，其中热敷为常用的家庭治疗方法。由于不同的热敷方式、温度、时间、频次及依从性，导致应用热敷治疗MGD到目前为止还没有统一标准。另外，热敷的不良反应如视物模糊、皮肤烫伤等，也没有引起临床足够重视。因此，为提高热敷的临床疗效及减少其不良反应，未来进行热敷的规范化指导或治疗很有必要。
Meibomian gland dysfunction (MGD) is a common ophthalmic disease, which is the main cause of evaporative dry eye. Population-based studies have suggested that the prevalence of MGD is high in Asia, with a reported incidence of 46.2% to 69.3%. Current modalities of MGD treatment include lid hygiene, warm compresses,massage, artificial lubricants, systemic and topical antibiotics, etc., among which warm compress is a common at-home treatment. Due to different eyelid warming methods, temperature, durations of heat application, frequency and compliance, there is no uniform standard for the application of warm compress to the treatment of MGD.In addition, adverse events of warm compress, such as blurred vision and thermal damage, have not attracted enough attention in clinical practice. Therefore, in order to improve the clinical efficacy of warm compress and reduce its adverse events, it is necessary to conduct standardized guidance or treatment of warm compress in the future. Based on the above considerations, this article will briefly review the application of warm compress to the treatment of MGD.
目的：探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题，以期改进培训方式。方法：以2020年4月在中山大学中山眼科中心培训的154名学员为对象，进行问卷调查，采用SPSS 20.0统计学软件进行数据分析。结果：共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%；住培则显著高于前者，分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断，90.8%的专硕选择了临床诊断(P=0.007)，94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001)；而住培仅为去除囊壁(P<0.001)。结论：睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高，并根据各类型学员的临床能力和认知差异，进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
目的：观察中药超声雾化联合针灸治疗睑板腺功能障碍(meibomain gland dysfunction，MGD)的临床疗效。方法：选取在新华医院就诊的7 7例(154眼)双 眼MGD患者，随机分为对照组(27例5 4眼)、中药超声雾化治疗组(雾化组；2 5例5 0眼)和中药超声雾化联合针灸治疗组(联合治疗组；2 5例5 0眼)。对照组接受睑板腺按摩治疗，雾化组在睑板腺按摩的基础上行中药超声雾化治疗，联合治疗组为进一步加用针灸治疗，治疗周期为4周。治疗前后收集患者双眼泪膜破裂时间(tear breakup time，BUT)、双眼基础泪液分泌试验数据(Schirmer I test，SIT)、双眼角膜荧光素染色评分(fluorescent，FL)、睑板腺分泌物性状评分(Meibomian Glandyielding Secretion Score，MGYSS)、睑缘异常评分(Eyelid Margin Abnormality Score，EMAS)以及主观症状积分等资料，并评价临床疗效。结果：治疗前三组BUT、SIT、F L、MGYSS、EMAS和主观评价得分等组间差异均无统计学意义(均P >0.05)。治疗4周后，各组受试者的BUT、SIT、F L评分、MGYSS评分、EMAS评分和主观评价评分与治疗前相比差异均具有统计学意义(均P < 0.05)；联合治疗组的上述指标分别与雾化组及对照组相比，差异均有统计学意义(P <0.05)。治疗后对照组的总有效率为51.85%(28眼/54眼)，雾化组为84%(42眼/50眼)，联合治疗组为96%(48眼/50眼)，联合治疗组总有效率与雾化组相比差异有统计学意义(P <0.05)。结论：中药超声雾化联合针灸治疗在改善MGD患者的睑板腺功能和减轻患者的干眼症状方面具有较好的临床疗效。
Objective: To observe the clinical efficacy of ultrasonic atomization fumigation of traditional Chinese medicine combined with acupuncture in the treatment of meibomian gland dysfunction (MGD). Methods: A total of 77 MGD patients (154 eyes) in Xinhua Hospital were selected and randomly divided into a control group (27 cases,54 eyes), a ultrasonic atomization of traditional Chinese medicine group (atomization group; 25 cases, 50 eyes),and a ultrasonic atomization of traditional Chinese medicine combined with acupuncture group (combined treatment group; 25 cases, 50 eyes). The control group received meibomian gland massage, the atomization group received meibomian gland massage and ultrasonic atomization of traditional Chinese medicine, and the combined treatment group received additional acupuncture treatment. The treatment period was 4 weeks. Tear breakup time (BUT), basal tear secretion test data (Schirmer I Test, SIT), corneal fluorescein staining score (FL), and Meibomian Gland Yielding Secretion Score (MGYSS), Eyelid Margin Abnormality Score (EMAS), Subjective Symptom Score (SSS) were collected and conduct clinical efficacy were evaluated. Results: There were no significant differences in BUT, SIT, FL, MGYSS, EMAS and SSS among the three groups (all P>0.05).After treatment of 4 weeks, the BUT, SIT, FL, MGYSS, EMAS and SSS in each group were improved significantly compared to baseline (P<0.05). The above indicators in combined treatment group were significantly different from atomization group (P<0.05) and control group (P<0.05). The total effective rates after treatment were 51.85% (28/54) in control group, 84% (42/50) in atomization group, and 96% (48/50) in combined treatment group. The difference in total effective rate between combined treatment group and atomization group was significant (P<0.05). Conclusion: Ultrasonic atomization of traditional Chinese medicine combined with acupuncture presents good clinical effects in improving the meibomian gland function of patients with MGD and alleviating the dry eye symptoms.
目的：分析复发与初发睑板腺囊肿患者的睑板腺组织形态学改变在活体共聚焦显微镜(in vivo confocal microscope，IVCM)下的表现及特点。方法：采用横断面研究方法，选取2018年10月至2019年4月在汕头大学·香港中文大学联合汕头国际眼科中心门诊就诊的10例复发性睑板腺囊肿患者、10例初发性睑板腺囊肿以及10例对照组作为观察对象。所有对象行眼科常规检查及IVCM检查。IVCM检测指标包括睑板腺开口面积、开口最短径、开口最长径、睑板腺开口附近腺管形态、睑板腺腺泡样结构形态，分析比较三组的计量指标。结果：复发性睑板腺囊肿组睑板腺开口短径(109.08±49.96) μm，开口长径(144.95±68.10) μm，开口面积为11 621.62 (3 976.49~24 828.82) μm2 ；初发性睑板腺囊肿组睑板腺开口短径(101.53±29.55) μm，开口长径(130.08±45.21) μm，开口面积10 615.07(5 813.29~18 275.44) μm2 ；对照组睑板腺开口短径(44.14±14.37) μm，开口长径(55.98±13.46) μm，开口面积2 233.29(1 437.72~2 945.65) μm2 。与对照组相比，复发性、初发性睑板腺囊肿组睑板腺开口短径、开口长径及开口面积均明显扩大，差异有统计学意义(P<0.05)；复发与初发睑板腺囊肿组之间差异不具有统计学意义(P>0.05)。复发性睑板腺囊肿组睑板腺腺管扩张，周边腺泡样结构纤维组织增生，伴有炎症细胞浸润。初发性睑板腺囊肿组睑板腺腺管扩张，周边腺泡样结构未见明显纤维组织增生。结论：IVCM可在活体下观察睑板腺囊肿患者睑板腺形态学上的微观改变，复发性睑板腺囊肿睑板腺腺泡样结构形态与初发性睑板腺囊肿表现有差异。
Background: To analyze the morphological changes of meibomian glands in patients with recurrent and primary meibomian gland cyst under in vivo confocal microscope (IVCM). Methods: A cross-sectional study was performed in Shantou International Eye Center from September 2018 to April 2019. Ten patients with recurrent meibomian cyst, 10 patients with primary meibomian cyst and 10 control subjects were selected in this clinical trial. All subjects received routine ophthalmologic examination and IVCM examination. IVCM examination parameters included open area of meibomian gland, and the maximum and minimum diameter of meibomian gland opening. Relevant parameters were analyzed and statistically compared among different groups. Results: The average minimum diameter of meibomian glands opening in the recurrent meibomian gland cyst group was (109.08±49.96) μm, the average maximum diameter of meibomian glands opening was (144.95±68.10) μm, and the median open area of meibomian gland was 11 621.62 (3 976.49–24 828.82) μm2 . In the primary meibomian gland cyst group, the average minimum diameter of meibomian glands opening was (101.53±29.55) μm, the average maximum diameter of meibomian glands opening was (130.08±45.21) μm, and the median open area of meibomian gland was 10 615.07 (5 813.29–18 275.44) μm2 . The opening of meibomian glands in both the recurrent and primary meibomian gland cyst groups was enlarged, which significantly differed from that in the control group (both P<0.05). No statistical significance was noted between the recurrent and primary meibomian gland cyst groups (P>0.05). The acinus structure around the gland tube was manifested with serious hypertrophic scar complicated with inflammatory cell infiltration. Conclusion: IVCM can detect the morphological changes of meibomian glands in meibomian gland cyst patients. The IVCM findings of recurrent and primary meibomian gland cyst are different.
目的：观察强脉冲光(intense pulse light，IPL)治疗睑板腺功能障碍(meibomian gland dysfunction，MGD)性干眼的临床效果。方法：选取2019年10月至2019年12月在东莞市东南部中心医院眼科门诊就诊的MGD性干眼患者64例(64只右眼)，随机分为对照组与观察组，每组32例。对照组采用睑板腺按摩联合常规药物治疗，观察组采用IPL联合睑板腺按摩及常规药物治疗，两组疗程均为6周；观察两组患者治疗前后干眼症状、体征及睑板腺功能变化。结果：治疗后两组干眼症状、体征及睑板腺功能均较治疗前明显改善，差异有统计学意义(P>0.05)；观察组治疗后2、4周干眼症状、体征及睑板腺功能评分改善优于对照组，差异有统计学意义(P<0.05)；治疗后6周两组各项观察指标差异无统计学意义(P>0.05)。经过6周治疗，观察组有效率为87.5%(28/32)，对照组有效率75%(24/32)，差异有统计学意义(P=0.021)。治疗期间两组均未发生不良反应。结论：IPL联合睑板腺按摩对MGD性干眼能有效减轻眼部不适症状、改善睑板腺功能，较单纯睑板腺按摩起效更快、效果更佳。
Objective: To observe the clinical effect of intense pulse light (IPL) on MGD dry eyes. Methods: Sixty-four patients(64 right eyes) with MGD dry eye from October 2019 to December 2019 were collected and randomly divided into control group (n=32) and observation group (n=32). The control group was treated with meibomian gland massage combined with conventional medicine, while the observation group was treated with IPL combined with meibomian gland massage and conventional medicine. The course of treatment of both groups was 6 weeks. The dry eye symptoms, dry eye signs and meibomian gland function changes were observed before and after treatment in both groups. Results: The dry eye symptoms, physical signs and meibomian gland function of the two groups after treatment were significantly improved compared with those before treatment (P>0.05). The improvement of dry eye symptoms, physical signs and meibomian gland function in observation group were better than those of the control group at two and four weeks after treatment (P<0.05), while there was no statistically significant difference between the two groups at 6 weeks after treatment (P>0.05). The effective rate in observation group was 87.5% (28/32) after 6 weeks treatment, while control group was 75% (24/32), the difference was statistically significant (P=0.021). No adverse reactions occurred in both groups during the treatment. Conclusion: IPL combined with meibomian gland massage can effectively reduce the ocular discomfort and improve the function of meibomian gland in MGD dry eyes,which is faster and more effective than meibomian gland massage alone.
目的：分析人眼的睑板腺形态学特征，探索睑板腺分析系统在眼表疾病的应用研究。方法：中山眼科中心入组正常受试者24例(42眼)，进行睑板腺红外摄影。选取受试者中的10例(20眼)在同型号的设备上由二名操作员分别进行睑板腺红外摄影。图像通过自行设计的分析软件对上睑结膜中央5条腺体形态学参数进行定量分析，对数据进行重复性测试。结果：测量的生物参数腺体直径为(0.48±0.09) mm，腺体长度为(5.25±0.68) mm，腺体面积为(2.12±0.53) mm，腺体形变系数为10.01±3.85，显影值为6.32±1.23，中央五条腺体占中央区域面积百分比为(10.94±2.20)%，腺体占上睑结膜面积百分比为(58.07±8.13)%。各指标两次测量值差异无统计学意义(P>0.05)。重复性分析结果显示：腺体各项生物参数的变异系数(coefficients of variation，CV)均小于5%，组内变异系数(intraclass correlation coefficient，ICC)均大于0.95。结论：睑板腺综合分析系统对腺体的形态学分析有良好的可靠性和一致性，有望为临床上对睑板腺腺体功能评估提供新的非侵入性参考指标。
Objective: To analyze the morphological characteristics of meibomian glands in human eyes and to explore the application research of meibomian glands analysis system in ocular surface diseases. Methods: A total of 24 healthy subjects were recruited by Zhongshan Ophthalmic Center to infrared photography of meibomian glands. Ten of healthy subjects were selected by the two operators for infrared photography of meibomian glands on the same model of equipment. The images were repeatedly measured and analyzed by the self-designed analysis software on the morphological measurements of the five glands in the center of the upper eyelid. Results: The measured biological parameters are shown below: the average gland diameter was (0.48±0.09) mm, the average gland length was (5.25±0.68) mm, the average gland area was (2.12±0.53) mm, the gland deformation coefficient was 10.01±3.85, the development value was 6.32±1.23, the percentage of the five central glands in the central area was (10.94±2.20)%, and the glands accounted for (58.07±8.13)% of the upper conjunctiva area. There was no statistical difference between the two measurements of each index (P>0.05). Repeatability analysis results showed that coefficients of variation (CV) of all biological parameters of glands were less than 5% and the intraclass correlation coefficient (ICC) in both groups were greater than 0.95. Conclusion: The Meibomian Gland Bioimage Analyzer provides good reliability and consistency for morphological measurements of the meibomian gland, and it is expected to provide new non-invasive indicators for clinical assessment of the meibomian glands function.
睑板腺功能障碍(meibomian gland dysfunction，MGD)是一种慢性、弥漫性的睑板腺病变，通常以睑板腺终末导管的阻塞或分泌的睑脂数量或质量发生改变为特征，临床上可以引起泪膜异常、角膜上皮损害、眼部刺激等干眼表现。MGD病因复杂且受多种因素影响，因此MGD发病机制的研究对于指导临床工作至关重要。本文对研究MGD的动物模型进行了介绍，并根据一些基础研究对MGD相关的细胞及分子机制等方面进行综述。
Meibomian gland dysfunction (MGD) is a chronic and diffuse disease of the eyelid gland. It is usually characterized by obstruction of the terminal duct of the eyelid gland or changes in the quantity/quality of the eyelid fat secreted. It can clinically cause dry eye symptoms such as abnormal tear film, corneal epithelial damage and eye irritation. The etiology of MGD is complex and affected by a variety of factors. Therefore, the study on the pathogenesis of MGD is of great importance to guide clinical work. This article introduces the animal research model of MGD, and reviews the cellular and molecular mechanisms related to MGD based on some basic research.
目的：对比两种不同部位M22优化脉冲激光治疗方法治疗睑板腺功能障碍(meibomian gland dysfunction，MGD)所致干眼的疗效。方法：回顾性分析汕头博德眼科医院干眼门诊患者105例，包括常规治疗组和改良治疗组两个组别，常规治疗组激光部位为下睑，改良治疗组激光部位为联合上下睑，所有患者行M22优化脉冲光治疗一个疗程(每月1次，共3次)，治疗前后均采用keratograph 5M干眼分析仪分析评估患者的泪河高度情况、泪膜破裂时间(break-up time，BUT)、角膜荧光染色(corneal fluorescence staining，CFS)和睑板腺排出能力等参数。采用t检验分析对比治疗前后变化情况。结果：患者治疗后泪河高度较强脉冲光治疗前明显增高，BUT时间延长，角膜荧光染色和睑板腺排出能力评分均有好转，每组治疗后与治疗前差异有统计学意义(P<0.01)，两组间治疗前后各参数差异比较均没有统计学意义。结论：两种不同部位M22优化脉冲激光治疗方法在治疗MGD导致的干眼方面有较好的效果，是较安全有效地治疗方法，两种不同方法治疗效果无明显差异。
Objective: To study the efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction (MGD). Methods: A total of 105 patients collected from Shantou Balder Eye Hospital were divided into two groups. The treatment position of the conventional group was lower eyelid, the other group was combined with upper and lower eyelid. All patients accepted M22 Optimal Pulsed Technology treatment for three times, once a month. Keratograph 5M dry eye analyzer was used to assess the height of tears river, break-up time (BUT), corneal fluorescence Staining(CFS)and meibomian gland expressibility. The results before and after laser treatment were compared using t-test in this study. Results: After treatment, the height of tear river, BUT, CFS and meibomian gland expressibility were improved. There was a statistically significant difference between each group after and before treatment (P<0.01). There was no significant difference before and after treatment between the two groups. Conclusion: The two methods of M22 Optimal Pulsed Technology are effective in treating dry eyes caused by MGD. There is no significant difference in the therapeutic effect between two methods.
