目的：评估优化强脉冲光(OPT)对睑板腺功能障碍(MGD)患者睑板腺形态和功能的影响。方法：前瞻性病例对照研究。选取2023年9月至2024年2月于潍坊眼科医院就诊的MGD患者60例60眼(选取右眼)。根据睑板腺缺失面积分为轻度、中度、重度三组，每组20例20眼。所有患者均接受双眼强脉冲光联合睑板腺按摩治疗，每2 wk 1次，共4次。观察并记录治疗前及末次治疗后3 mo眼表疾病指数(OSDI)、角膜荧光素染色(CFS)、非侵入性平均泪膜破裂时间(NIBUTav)、非侵入性泪河高度(NITMH)等眼表功能指标，睑板腺排出能力评分(MGES)、睑板腺分泌物评分(MGYSS)等睑板腺功能指标； 活体共聚焦显微镜(IVCM)在细胞水平上观察睑板腺腺泡单元密度(MGAUD)、腺泡间炎症细胞密度(ICD)、睑板腺腺泡最长直径(MGALD)、睑板腺腺泡最短直径(MGASD)等微观结构。结果：治疗前基线水平上，三组间NITMH无差异(P>0.05)； 三组间NIBUTav、MGES、MGYSS、MGAUD、MGALD、MGASD两两比较均有差异(均P<0.05)； 中、重度组的OSDI、CFS、ICD与轻度组分别比较均有差异(均P<0.05)，但中、重度组间无差异(均P>0.05)。治疗后3 mo，三组患者NITMH无显著改变(均P>0.05)，剩余指标比较结果如下：轻度组患者全部指标均有改善(均P<0.05)； 中度组除MGASD治疗前后无差异(P>0.05)，其余指标均有改善(均P<0.05)； 重度组治疗后OSDI、CFS、NIBUTav显著改善(均P<0.05)，MGES、MGYSS变化无差异(均P>0.05)，IVCM下各项睑板腺腺泡参数MGAUD、ICD、MGALD、MGASD均无差异(均P>0.05)。结论：OPT可以改善不同睑板腺缺失程度MGD患者的各项眼表功能，改善轻、中度MGD患者的睑板腺排出能力和睑酯的性状，并在细胞水平上改善睑板腺腺泡各项参数。重度患者大部分腺泡功能丧失，腺泡结构无法逆转，但仍可通过治疗改善MGD患者的症状和体征，延缓病情发展。

AIM: To assess the impact of optimized pulsed technology(OPT)on the morphological and functional changes of meibomian glands in patients with meibomian gland dysfunction(MGD).METHODS: This prospective case-control study enrolled 60 MGD patients(60 right eyes)treated at Weifang Eye Hospital from September 2023 to February 2024. Patients were categorized into mild, moderate, and severe groups based on the extent of meibomian gland loss, with 20 cases(20 eyes)per group. Treatments consisted of bilateral OPT combined with meibomian gland massages, administered biweekly over four sessions. Ocular surface function indicators including the ocular surface disease index(OSDI), corneal fluorescein staining(CFS), non-invasive average tear break-up time(NIBUTav), and non-invasive tear meniscus height(NITMH), as well as meibomian gland function parameters such as meibomian gland expressibility score(MGES)and meibomian gland secretion score(MGYSS)were observed and recorded before treatment and at 3 mo after final treatment. Cellular-level assessments using in vivo confocal microscopy(IVCM)examined meibomian gland acinar unit density(MGAUD), inflammatory cell density(ICD), meibomian gland acinar longest diameter(MGALD)and meibomian gland acinar shortest diameter(MGASD).RESULTS: At baseline, no significant differences were found in NITMH across groups(P>0.05). Statistical significance were observed in NIBUTav, MGES, MGYSS, MGAUD, MGALD, and MGASD(all P<0.05). Compared to the mild group, the moderate and severe groups showed significant differences in OSDI, CFS, and ICD(all P<0.05), though no significant differences existed between moderate and severe groups(all P>0.05). At 3 mo after treatment, all groups showed no significant differences in NITMH(all P>0.05). All parameters improved significantly in the mild group(all P<0.05); all indicators improved in the moderate group(P>0.05), except for MGASD before and after treatment(all P<0.05); significant improvements were noted in OSDI, CFS, and NIBUTav in the severe group(all P<0.05), while MGES and MGYSS did not differ significantly(all P>0.05). IVCM parameters(MGAUD, ICD, MGALD, and MGASD)showed no significant change in the severe group(all P>0.05).CONCLUSION:OPT effectively enhances various ocular surface functions and improves gland expressibility and secretion quality in mild to moderate MGD cases, while also positively impacting certain cellular parameters. In severe cases, where most acinar functions are lost and structural reversibility is limited, OPT can still mitigate MGD symptoms and decelerate disease progression.

山东省医药卫生科技发展计划项目(No.202207020298)