Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome
Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome
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DOI：
10.1097/ico.0000000000002025
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发表时间：
2019-12-01
期刊：
影响因子：
2.8
通讯作者：
Nijvipakul, Sarayut
中科院分区：
文献类型：
--
作者：
Lekhanont, Kaevalin;Jongkhajornpong, Passara;Nijvipakul, Sarayut
目的：应用红外meibography研究Stevens-Johnson综合征（SJS）患者的眼表及睑板腺特征。方法：这是一项单中心、前瞻性、非对照、观察性研究。32例泰国SJS患者（64只眼睛）持续1年或更长时间（1-44年）。所有参与者都接受了全面的眼科检查，包括裂隙灯生物显微镜、泪膜半月板高度、荧光素泪液破裂时间、眼表荧光素染色、眼睑形态、Schirmer 1试验、睑板腺表达能力和上、下眼睑计数图，使用安装在裂隙灯生物显微镜上的非接触式红外计数仪。结果：平均年龄42.2±17.7岁（范围4 ~ 68岁）。29例（90.6%）患者急性期有严重眼部并发症史。药物是SJS最常见的原因（93.8%）。23例（71.9%）患者由于无腺体表达而无法评估Meibum质量。所有患者均发现上、下眼睑睑板腺部分或完全丧失。睑板腺脱落程度与泪液破裂时间（P < 0.001）、睑板质量（P < 0.001）、睑板表达性（P < 0.001）、眼表染色（P < 0.001）、睑板粘连（P = 0.027）、角膜缘干细胞缺乏（P = 0.003）等长期眼部后遗症的存在显著相关。结论：SJS与阻塞性睑板腺功能障碍有关。睑板腺脱落的严重程度与干眼检查异常、主观睑板腺评估以及SJS的其他眼部后遗症有关。
Purpose: To investigate ocular surface and meibomian gland characteristics using infrared meibography in patients with Stevens-Johnson syndrome (SJS).Methods: This is a single-center, prospective, noncontrolled, observational study. Thirty-two Thai patients (64 eyes) with SJS for 1 year or longer (1-44 years) were enrolled in the study. All participants underwent a comprehensive ophthalmic examination including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear breakup time, ocular surface fluorescein staining, eyelid morphology, Schirmer 1 test, meibomian gland expressibility, and upper and lower eyelid meibography using a noncontact infrared meibograph mounted on a slit-lamp biomicroscope.Results: The mean age was 42.2 +/- 17.7 years (range, 4-68 years). Twenty-nine patients (90.6%) had a history of severe ocular complications in the acute stage of the disease. Medications were the most common cause of SJS (93.8%). Meibum quality could not be assessed in 23 patients (71.9%) due to no glands expressible. Partial or complete loss of the meibomian glands in either the upper or lower eyelid was found in all patients. The degree of meibomian gland dropout significantly correlated with tear breakup time (P < 0.001), meibum quality (P < 0.001), meibum expressibility (P < 0.001), ocular surface staining (P < 0.001), and presence of long-term ocular sequelae including symblepharon (P = 0.027) and limbal stem cell deficiency (P = 0.003).Conclusions: SJS is associated with obstructive meibomian gland dysfunction. The severity of meibomian gland dropout has a relationship with abnormal dry eye tests, subjective meibomian gland evaluation, and other ocular sequelae of SJS.