IPL是目前国际上新兴起的以光脉冲治疗睑板腺功能障碍引起的干眼症的治疗方法。本文主要是关于IPL在睑板腺功能障碍中的研究进展的论述,主要从睑板腺功能障碍的发病机制,IPL的治疗机制,IPL在临床中的联合运用,IPL的优缺点等方面展开论述,探究其在国内外的发展趋势,希望对IPL治疗睑板腺功能障碍进行更深入的了解。同时本次综述分析IPL治疗睑板腺功能障碍的原理主要是热作用,提出了中医上可采用艾灸、热敷等疗法代替IPL治疗睑板腺功能障碍导致的干眼症的治疗可行性和临床意义。
IPL is a newly emerging treatment method for dry eye caused by meibomian gland dysfunction with light pulses. This article mainly discusses the research progress of IPL in meibomian gland dysfunc-tion, mainly from the pathogenesis of meibomian gland dysfunction, the treatment mechanism of IPL, the combined use of IPL in clinical, the advantages and disadvantages of IPL, etc., explores its development trend at home and abroad, and hopes to have a deeper understanding of IPL in the treatment of meibomian gland dysfunction. At the same time, this review analyzes that the princi-ple of IPL in the treatment of meibomian gland dysfunction is mainly the effect of heat, and propos-es the feasibility and clinical significance that moxibustion, hot compress and other therapies can be used in traditional Chinese medicine to replace IPL in the treatment of dry eye caused by mei-bomian gland dysfunction.
IPL is a newly emerging treatment method for dry eye caused by meibomian gland dysfunction with light pulses. This article mainly discusses the research progress of IPL in meibomian gland dysfunction, mainly from the pathogenesis of meibomian gland dysfunction, the treatment mechanism of IPL, the combined use of IPL in clinical, the advantages and disadvantages of IPL, etc., explores its development trend at home and abroad, and hopes to have a deeper understanding of IPL in the treatment of meibomian gland dysfunction. At the same time, this review analyzes that the principle of IPL in the treatment of meibomian gland dysfunction is mainly the effect of heat, and proposes the feasibility and clinical significance that moxibustion, hot compress and other therapies can be used in traditional Chinese medicine to replace IPL in the treatment of dry eye caused by meibomian gland dysfunction.
Keywords:IPL, Meibomian Gland Dysfunction, Dry Eye, Clinical Application of IPL
金茹意,刘 芳. IPL在睑板腺功能障碍中的研究进展Research Progress of IPL in Meibomian Gland Dysfunction[J]. 临床医学进展, 2023, 13(01): 714-722. https://doi.org/10.12677/ACM.2023.131104
参考文献References邹宗正, 王慧凤, 杨玲玲. 睑板腺功能障碍发病机制的研究进展[J]. 眼科学报, 2022, 37(4): 335-341.Al-Saedi, Z., Zimmerman, A., Devi Bachu, R., et al. (2016) Dry Eye Disease: Present Challenges in the Management and Future Trends. Current Pharmaceutical Design, 22, 4470-4490.
<br>https://doi.org/10.2174/1381612822666160614012634Mejía, L.F., Gil, J.C. and Jaramillo, M. (2019) Intense Pulsed Light Therapy: A Promising Complementary Treatment for Dry Eye Disease. Archivos de la Sociedad Española de Oftalmología (English Edition), 94, 331-336.
<br>https://doi.org/10.1016/j.oftale.2019.03.003Lemp, M.A., Crews, L.A., Bron, A.J., Foulks, G.N. and Sullivan, B.D. (2012) Distribution of Aqueous-Deficient and Evaporative Dry Eye in a Clinic-Based Patient Cohort: A Retrospec-tive Study. Cornea, 31, 472-478.
<br>https://doi.org/10.1097/ICO.0b013e318225415a熊小菊, 王小红. 光子嫩肤技术治疗180例色素性沉着皮肤病疗效观察[J]. 实用中西医结合临床, 2012, 12(2): 53-54.Jiang, M., Yan, F., Avram, M. and Lu, Z. (2017) A Prospective Study of the Safety and Efficacy of a Combined Bipolar Radiofrequency, Intense Pulsed Light, and Infra-red Diode Laser Treatment for Global Facial Photoaging. Lasers in Medical Science, 32, 1051-1061. <br>https://doi.org/10.1007/s10103-017-2207-9Vora, G.K. and Gupta, P.K. (2015) Intense Pulsed Light Therapy for the Treatment of Evaporative Dry Eye Disease. Current Opinion in Ophthalmology, 26, 314-318. <br>https://doi.org/10.1097/ICU.0000000000000166黄镇钦, 董天慧, 詹展基, 周洁龙, 符敏. 睑板腺功能障碍发病机制及患病危险因素[J]. 国际眼科纵览, 2017, 41(1): 48-52.Butovich, I.A. (2013) Tear Film Lipids. Experimental Eye Research, 117, 4-27.Joffre, C., Souchier, M., Grégoire, S, et al. (2008) Differences in Meibo-mian Fatty Acid Composition in Patients with Meibomian Gland Dysfunction and Aqueous-Deficient Dry Eye. British Journal of Ophthalmology, 92, 116-119.
<br>https://doi.org/10.1136/bjo.2007.126144Baer, A.N., Costello, P.B. and Green, F.A. (1990) Free and Esteri-fied 13(R,S)-Hydroxyoctadecadienoic Acids: Principal Oxygenase Products in Psoriatic Skin Scales. Journal of Lipid Research, 31, 125-130.
<br>https://doi.org/10.1016/S0022-2275(20)42766-X阎峻. 睑板腺功能障碍性干眼的临床研究[J]. 当代医学, 2011, 17(34): 98-99.The Definition and Classification of Dry Eye Disease: Report of the Definition and Classifi-cation Subcommittee of the International Dry Eye Workshop (2007). The Ocular Surface, 5, 75-92.
<br>https://doi.org/10.1016/S1542-0124(12)70081-2Roda, M., Corazza, I., Bacchi Reggiani, M. L., Pellegrini, M., Taroni, L., Giannaccare, G. and Versura, P. (2020) Dry Eye Disease and Tear Cytokine Levels—A Meta-Analysis. In-ternational Journal of Molecular Sciences, 21, Article No. 3111. <br>https://doi.org/10.3390/ijms21093111Arciniega, J.C., Nadji, E.J. and Butovich, I.A. (2011) Effects of Free Fatty Acids on Meibomian Lipid Films. Experimental Eye Research, 93, 452-459. <br>https://doi.org/10.1016/j.exer.2011.06.007邱翎, 孔丽萍, 杨建荣, 等. TL对脂质泪液不足型干眼症影响的初步研究[J]. 临床眼科杂志, 2007, 15(2): 106-109.Liu, Y., Chen, D., Chen, X., Kam, W.R., Hatton, M.P. and Sullivan, D.A. (2019) Hypoxia: A Breath of Fresh Air for the Meibomian Gland. The Ocular Surface, 17, 310-317. <br>https://doi.org/10.1016/j.jtos.2018.12.001Knop, E., Knop, N., Millar, T., Obata, H. and Sullivan, D.A. (2011) The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the Meibomian Gland. Investigative Ophthalmology & Visual Science, 52, 1938-1978. <br>https://doi.org/10.1167/iovs.10-6997cNagymihályi, A., Dikstein, S. and Tiffany, J.M. (2004). The Influence of Eyelid Temperature on the Delivery of Meibomian Oil. Experiment Eye Research, 78, 367-370. <br>https://doi.org/10.1016/S0014-4835(03)00197-0Dell, S.J. (2017) Intense Pulsed Light for Evaporative Dry Eye Disease. Clinical Ophthalmology, 11, 1167-1173.
<br>https://doi.org/10.2147/OPTH.S139894徐倩, 张敏, 宣姗姗. 睑板腺热敷按摩对睑板腺功能障碍型干眼症的影响[J]. 当代医学, 2019, 25(14): 173-174.Enríquez-de-Salamanca, A., Castellanos, E., Stern, M. E., et al. (2010) Tear Cytokine and Chemokine Analysis and Clinical Correlations in Evaporative-Type Dry Eye Disease. Molecu-lar Vision, 16, 862-873.Maskin, S.L. (2010) Intraductal Meibomian Gland Probing Relieves Symptoms of Ob-structive Meibomian Gland Dysfunction. Cornea, 29, 1145-1152. <br>https://doi.org/10.1097/ICO.0b013e3181d836f3Bondre, V.P., et al. (2009) Genetic Characterization of Baga-za Virus (BAGV) Isolated in India and Evidence of Anti-BAGV Antibodies in Sera Collected from Encephalitis Patients. Journal of General Virology, 90, 2644-2649.
<br>https://doi.org/10.1099/vir.0.012336-0Craig, J.P., Chen, Y.H. and Turnbull, P.R. (2015) Prospective Trial of Intense Pulsed Light for the Treatment of Meibomian Gland Dysfunction. Investigative Ophthalmology and Visual Sci-ence, 56, 1965-1970.
<br>https://doi.org/10.1167/iovs.14-15764Gupta, P.K., Vora, G.K., Matossian, C., Kim, M. and Stinnett, S. (2016) Outcomes of Intense Pulsed Light Therapy for Treatment of Evaporative Dry Eye Disease. Canadian Journal of Oph-thalmology, 51, 249-253.
<br>https://doi.org/10.1016/j.jcjo.2016.01.005Karaca, E.E., Evren Kemer, Ö. and Özek, D. (2020) Intense Regu-lated Pulse Light for the Meibomian Gland Dysfunction. European Journal of Ophthalmology, 30, 289-292. <br>https://doi.org/10.1177/1120672118817687刘畅, 张琛, 黄悦, 等. 单纯强脉冲光治疗睑板腺功能障碍的疗效观察[J]. 中华实验眼科杂志, 2019, 37(3): 185-189. <br>https://doi.org/10.3760/cma.j.issn.2095-0160.2019.03.005Li, D., Lin, S.-B. and Cheng, B. (2019) Intense Pulsed Light Treatment for Meibomian Gland Dysfunction in Skin Types III/IV. Photobiomodulation, Photomedicine, and Laser Surgery, 37, 70-76.
<br>https://doi.org/10.1089/photob.2018.4509Arita, R., Fukuoka, S. and Morishige, N. (2019) Therapeutic Effi-cacy of Intense Pulsed Light in Patients with Refractory Meibomian Gland Dysfunction. Ocular Surface, 17, 104-110. <br>https://doi.org/10.1016/j.jtos.2018.11.004Liu, R., Rong, B., Tu, P., et al. (2017) Analysis of Cytokine Levels in Tears and Clinical Correlations after Intense Pulsed Light Treating Meibomian Gland Dysfunction. American Journal of Ophthalmology, 183, 81-90.
<br>https://doi.org/10.1016/j.ajo.2017.08.021Rong, B., Tang, Y., Tu, P., et al. (2018) Intense Pulsed Light Ap-plied Directly on Eyelids Combined with Meibomian Gland Expression to Treat Meibomian Gland Dysfunction. Photo-medicine and Laser Surgery, 36, 326-332.
<br>https://doi.org/10.1089/pho.2017.4402刘凡菲, 李炜, 刘祖国, 陈文生. 角膜上皮屏障功能的研究现状[J]. 中华眼科杂志, 2016, 52(8): 631-635.Guilloto Caballero, S., García Madrona, J.L. and Colmenero Reina, E. (2017) Effect of Pulsed Laser Light in Patients with Dry Eye Syndrome. Archivos de la Sociedad Española de Oftalmología, 92, 509-515.
<br>https://doi.org/10.1016/j.oftal.2016.12.018Vigo, L., Giannaccare, G., Sebastiani, S., Pellegrini, M. and Ca-rones, F. (2019) Intense Pulsed Light for the Treatment of Dry Eye Owing to Meibomian Gland Dysfunction. Journal of Visualized Experiments, 146, e57811.
<br>https://doi.org/10.3791/57811Rong, B., Tang, Y., Liu, R., et al. (2018) Long-Term Effects of Intense Pulsed Light Combined with Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction. Photomedicine and Laser Surgery, 36, 562-567.
<br>https://doi.org/10.1089/pho.2018.4499周晓晴, 马晓晔, 魏锐利. 眼周区强脉冲光治疗睑板腺功能障碍的疗效观察[J]. 中国激光医学杂志, 2018, 27(2): 125.张宝冬, 石薇, 张贵森, 等. 强脉冲光治疗睑板腺功能障碍性干眼的临床研究[J]. 山西医药杂志, 2018, 47(9): 1048-1050.法拉. 大连眼科门诊 VDT 工作人员干眼症及其强脉冲光治疗的效果调查[D]: [硕士学位论文]. 大连: 大连医科大学, 2017.姜静. 优化脉冲光治疗干眼疗效观察[J]. 中国激光医学杂志, 2019, 28(2): 118-120.李苛苛, 童楠, 陈赛男. OPT优化脉冲光治疗干眼症的护理[J]. 中国医药指南, 2017, 15(34): 225-226.童楠. M22优化脉冲光联合专科护理干预治疗干眼的临床疗效观察[J]. 全科护理, 2018, 16(23): 2882-2885.李媛. 睑板腺按摩联合强脉冲光治疗睑板腺功能障碍性干眼的临床研究[D]: [硕士学位论文]. 济南: 山东大学, 2017.叶健章, 尹转通, 刘斐. 睑板腺按摩联合强脉冲光治疗睑板腺功能障碍性干眼病[J]. 深圳中西医结合杂志, 2018, 28(11): 141-142.杨磊, 李宁. 睑板腺按摩联合强脉冲光治疗睑板腺功能障碍性干眼的临床分析[J]. 智慧健康, 2018, 4(8): 107-108.Huang, K.-Y., Liang, S., Lu, L., Morgan, P.J. and Zhang, J.-B. (2016) To Understand Moxibustion from the Biological Effect of Local Thermal Stimulation. World Journal of Acupuncture-Moxibustion, 26, 31-37, 48.
<br>https://doi.org/10.1016/S1003-5257(17)30060-0Nichols, K.K., et al. (2011) The International Workshop on Meibomian Gland Dysfunction: Executive Summary. Investigative Ophthalmology & Visual Science, 52, 1922-1929. <br>https://doi.org/10.1167/iovs.10-6997a孙玉芹, 丁刚, 王凌云, 等. 银离子治疗糖尿病睑板腺功能障碍的疗效及护理要点[J]. 国际医药卫生导报, 2019, 25(18): 3151-3152. <br>https://doi.org/10.3760/cma.j.issn.1007-1245.2019.18.047戴鹏飞, 李颖, 王玉倩, 等. 睑板腺分析系统评估强脉冲光联合睑板腺按摩治疗睑板腺功能障碍相关干眼的有效性[J]. 中华眼视光学与视觉科学杂志, 2021, 23(12): 896-902.何文婷, 卞薇, 李国琴, 周青青. 恒温氧气超声雾化联合睑板腺疏通治疗睑板腺功能障碍性干眼症的效果[J]. 临床与病理杂志, 2021, 41(6): 1267-1273张俊霞, 刘洋. 规范化物理治疗在睑板腺功能障碍中的疗效[J]. 延安大学学报(医学科学版), 2021, 19(4): 39-41.金尚丽, 曾锦, 香淑媚, 陈智慧. 术前睑板腺功能障碍对白内障病人术后视觉质量的影响[J]. 实用老年医学, 2020, 34(3): 229-232.哈米拉∙普尔凯提. 术前物理治疗对睑板腺功能障碍的白内障患者术后眼表影响的临床观察[D]: [硕士学位论文]. 乌鲁木齐: 新疆医科大学, 2021.孙圣书, 黄悦. 抗生素治疗睑板腺功能障碍的研究进展[J]. 国际眼科杂志, 2022, 22(5): 827-832.程配. 常规干预联合睑板腺按摩护理用于睑板腺功能障碍性干眼患者眼部症状改善及满意度观察[J]. 山西医药杂志, 2021, 50(15): 2362-2365.付伟伟, 张国亮, 刘志顺, 等. 核桃壳眼镜灸改善干眼症状随机对照试验[J]. 中国针灸, 2018, 38(11): 1177-1182.胥静. 核桃壳眼镜灸治疗干眼的临床疗效评价[D]: [硕士学位论文]. 北京: 北京中医药大学, 2018.李燕飞, 刘苈莹, 祝菊蕊. 雷火灸联合睑板腺按摩治疗睑板腺功能障碍性干眼的疗效观察[J]. 微创医学, 2019, 14(4): 473-475.李忠平. 温灸(雷火灸)对干眼症患者睑板腺形态学的影响分析[J]. 贵州医药, 2016, 40(8): 842-844.邓小艳, 关玮丽, 米珍. 雷火灸联合玻璃酸钠滴眼液治疗干眼临床观察[J]. 河北中医, 2016, 38(8): 1216-1219.赵磊, 左韬, 王方媛, 迟凯耀. 眼周穴位雷火灸治疗干眼症的系统评价与Meta分析[J]. 国际眼科志, 2019, 19(8): 1338-1343.