睑板腺功能障碍可导致眼表微环境失衡，眼部不适及视功能障碍，深刻影响着患者的视觉生活质量。睑板腺按摩作为一种通过机械挤压睑板腺疏通睑板腺开口，排出异常睑酯的治疗手段，目前已被广泛应用于临床干眼患者，成为睑板腺功能障碍最常见的物理治疗方法。但由于睑板腺按摩的操作手法多样，不同医疗机构所积累的操作经验也不尽相同，导致在治疗过程中存在较多潜在风险，若操作不当，可造成眼部感染、眼睑红肿、结膜水肿出血，甚至角膜损伤。因此，制定标准化的操作流程，规范睑板腺按摩治疗非常重要。然而，目前尚缺乏全面、系统化且规范化的睑板腺按摩操作的临床实践指导。鉴于此，中山大学中山眼科中心联合全国19所医疗机构进行反复修订，于2023年12月17日在全国团体标准信息平台发布《睑板腺按摩操作流程》的团体标准。文章对该团体标准进行深度解读，以更好指导临床工作。
Meibomian gland dysfunction (MGD) can lead to an imbalance in the ocular surface microenvironment, eye discomfortable, and visual impairment, thereby profoundly affecting the visual quality of life of patients. Meibomian gland massage is now widely used in clinical patients, serving as the most prevalent physical therapy for MGD. The mechanism of meibomian gland massage is to open the meibomian gland opening by squeezing the meibomian gland and expel abnormal eyelid esters. However, due to the diverse techniques used in meibomian gland massage and the varying levels of operational experience accumulated by different medical institutions, there are many potential risks in treatment process. If medical staff operate improperly, it can cause eye infections, eyelid redness and swelling, conjunctival edema and bleeding, and even corneal damage. Therefore, it is crucial to establish the standardized procedure of meibomian gland massage therapy. Yet, there is currently lack of comprehensive, systematic, and standardized clinical practice guidance. Thus, the Zhongshan Ophthalmic Center, Sun Yat-sen University, in collaboration with 19 medical institutions across the country, has released the group standard for Operation Procedure of Meibomian Gland Massage on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group standard to guide clinical work better.
睑板腺功能障碍(meibomian gland dysfunction, MGD)是一种慢性弥漫性睑板腺疾病，可引起眼红、眼干、异物感等眼部不适，影响患者的眼健康及生活质量。强脉冲光(intense pulsed light, IPL)作为一种新兴有效的物理治疗方法，目前已广泛应用于治疗MGD及其他常见的眼表疾病，如蠕形螨性睑缘炎、睑缘炎相关角结膜病变、复发性睑板腺囊肿等。在IPL临床应用中，规范的操作是保障治疗有效性与安全性的关键。为更好指导和规范临床眼科医护人员的IPL治疗操作，由中山大学中山眼科中心牵头，联合全国19所医疗机构，经过多次修订，于2023年12月17日在全国团体标准信息平台发布了《强脉冲光治疗睑板腺功能障碍操作流程》的团体标准。文章旨在对该团体标准进行深度解读，详细阐述操作中的重点、难点与操作细节，以更好地指导临床工作。
Meibomian gland dysfunction is a chronic diffuse meibomian gland disease that can cause eye discomfort such as redness, dryness, and foreign body sensation in patients, and influence their eye health and quality of life. Intense pulsed light (IPL), as an effective physical therapy for meibomian gland dysfunction, is being used to treat meibomian gland dysfunction and related diseases widely, such as demodex blepharitis, keratoconjunctivitis, recurrent meibomian gland cysts and so on.. In the clinical application of IPL, standardized procedures are key to ensuring the effectiveness and safety of treatment. In order to better guide and standardize the IPL treatment operation of clinical ophthalmic medical workers, led by the Zhongshan Ophthalmic Center, Sun Yat-sen University, and joined with 19 medical institutions across the country, after multiple revisions, the group standard " Operation Procedure of Intense Pulsed Light for Meibomian Gland Dysfunction" was released on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group's standards, detailing the key points, difficulties, and operational details of specific operations, in order to better guide clinical work.
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.
