强脉冲光治疗重度慢性眼移植物抗宿主病的安全性和有效性

Safety and efficacy of intense pulsed light in the treatment of severe chronic ocular graft-versus-host disease

摘要:

目的：探讨强脉冲光治疗重度慢性眼移植物抗宿主病(coGVHD)的安全性和有效性。方法：前瞻性随机对照研究。选取于2022-01/09就诊于徐州医科大学附属医院，既往行异基因造血干细胞移植(allo-HSCT)，并经我院血液科、眼科诊断为重度coGVHD患者35例35眼，若双眼符合入组标准，则随机选择一眼纳入研究，若单眼符合入组标准，则选择此眼纳入研究。对照组患者以右旋糖酐羟丙甲纤维素滴眼液每天4次、环孢素滴眼液每天2次滴眼治疗，试验组在此基础上加以强脉冲光治疗，每2wk 1次，共4次，在治疗前、治疗后2wk， 1、2mo进行评估。评估指标包括：眼表疾病指数(OSDI)评分、最佳矫正视力(BCVA)、眼压(IOP)、泪河高度(TMH)、无创泪膜破裂时间(NIBUT)、结膜充血(CIS)、睑板腺面积比例(MGAP)、睑板腺功能评估(MGE)、角膜荧光素染色评分(CFS)、结膜丽丝胺绿染色评分(CLGS)、睑缘异常评分(LMAS)、Schirmer Ⅰ试验(SⅠt)。结果：治疗后两组患者OSDI评分、TMH、NIBUT、BCVA、CFS、CLGS、CIS均较治疗前改善(均P<0.05)，其中NIBUT、CFS、CLGS试验组改善更加明显。对照组上下眼睑MGAP、MGE及LMAS治疗前后均无明显改变(P>0.05)，试验组除上眼睑MGAP较治疗前无差异外(P>0.05)，下眼睑MGAP、上下眼睑MGE及LMAS均较治疗前改善(P<0.05)。两组患者治疗前后SⅠt和IOP均无差异(P>0.05)。随访期间患者并未出现治疗区域皮肤烫伤、红肿、睫毛脱落等不良反应。结论：强脉冲光治疗重度慢性眼移植物抗宿主病安全有效，可显著改善患者症状及体征、提高泪膜稳定性。

Abstract:

AIM: To investigate the safety and efficacy of intense pulsed light in the treatment of severe chronic ocular graft-versus-host disease.METHODS: Prospective randomized controlled study. A total of 35 cases(35 eyes), who had a history of allogenic hematopoietic stem cell transplantation(allo-HSCT), admitted to the Affiliated Hospital of Xuzhou Medical University from January to September 2022 and were diagnosed by our hospital's hematology and ophthalmology departments with severe chronic ocular graft-versus-host disease(coGVHD)were selected. One eye was randomly selected for inclusion in the study if both eyes met the enrollment criteria, and the eye was selected if a single eye met the enrollment criteria. All patients were administrated with Dextran and Hypromellose eye drops 4 times a day and Cyclosporine eye drops twice a day. The experimental group was additionally treated with intense pulsed light, once every two weeks a week, for 4 times in total. The evaluation indicators were evaluated before treatment and 2wk, 1 and 2mo after treatment. The evaluation indicators include ocular surface disease index(OSDI)score, best corrected visual acuity(BCVA), intraocular pressure(IOP), tear meniscus height(TMH), non-invasive break-up time(NIBUT), conjunctival injection score(CIS), meibomian gland area proportion(MGAP), meibomian gland evaluation(MGE), cornea fluorescein staining(CFS), conjunctival lissamine green staining(CLGS), lid margin abnormality score(LMAS), and Schirmer's Ⅰ test(SⅠt).RESULTS: After treatment, OSDI score, TMH, NIBUT, BCVA, CFS, CLGS, and CIS improved in both groups compared with those before treatment(all P<0.05), with NIBUT, CFS and CLGS showing more significant improvements in the test group. In the control group, MGAP, MGE of the upper and lower eyelids and LMAS did not change significantly before and after treatment(P>0.05), while in the experimental group, MGAP of the lower eyelids, MGE of upper and lower eyelids and LMAS improved compared with those before treatment(P<0.05), except for MGAP of the upper eyelids, which did not differ from that before treatment(P>0.05). There was no difference in SⅠt and IOP between the two groups before and after treatment(P>0.05). Patients did not experience adverse reactions such as skin burns, redness and swelling in the treated area and eyelash loss during the follow-up period.CONCLUSION: Intense pulsed light is safe and effective in the treatment of severe coGVHD, which can significantly improve the symptoms and signs of patients and enhance the stability of tear film.