目的

探讨射频技术治疗睑板腺功能障碍（MGD）相关干眼的安全性与有效性。

方法

选取2024年4月至2024年6月于首都医科大学附属北京同仁医院眼科中心就诊的MGD相关干眼患者共21例（42只眼）作为研究对象。其中，男性7例（14只眼），女性14例（28只眼）；年龄23～73岁，平均年龄为（47.3±17.2）岁。所有患者均接受双眼睑射频治疗，每周1次，每次20 min，共4次。治疗前后的非接触眼压、眼表疾病指数问卷（OSDI）评分、症状视觉模拟量表（VAS）评分、睑板腺分泌能力评级、睑酯质量评分、荧光素染色泪膜破裂时间、角膜荧光素染色评分、SchirmerⅠ试验、最佳矫正视力、泪河高度（TMH）、泪膜脂质层厚度及非侵入性泪膜破裂时间符合正态分布，以±s描述，不同时间的比较采用单因素重复测量方差分析，治疗前与末次随访时各指标的比较采用配对t检验。

结果

MGD相关干眼患者治疗前、治疗后1周、治疗后2周、治疗后3周及治疗后4周OSDI评分分别为（55.86±20.80）分、（46.56±20.06）分、（33.30±18.75）分、（35.60±17.48）分及（25.99±11.15）分；烧灼或刺痛感、瘙痒感、异物感、眼干涩、畏光、眼疼痛及眼不适VAS评分分别为（47.71±22.71）分、（42.90±23.28）分、（35.57±19.82）分、（31.86±19.49）分、（28.67±17.83）分、（46.95±20.12）分、（45.95±21.89）分、（34.05±16.02）分、（31.14±21.90）分、（22.95±15.57）分、（53.57±25.48）分、（48.48±22.22）分、（36.43±19.23）分、（35.76±21.89）分、（22.48±12.71）分、（65.67±27.58）分、（55.90±23.22）分、（43.76±22.99）分、（37.86±18.79）分、（28.90±14.22）分、（53.71±21.57）分、（45.57±23.25）分、（36.38±23.47）分、（29.05±18.28）分、（21.10±12.66）分、（53.86±20.82）分、（44.55±19.23）分、（31.71±17.87）分、（33.50±16.98）分、（24.71±10.87）分、（70.67±17.84）分、（51.90±20.77）分、（39.52±21.52）分、（34.10±18.23）分及（24.81±12.86）分；不同时间OSDI评分和不适VAS评分的比较，差异均有统计学意义（F＝9.103，2.958，5.870，7.211，9.334，8.457，9.103，19.340；P＜0.05）。治疗后第4周与治疗前OSDI评分和不适VAS评分比较，差异有统计学意义（t＝-5.22，-8.43，-6.91，-7.85，-8.98，-9.32，-9.16，-13.85；P＜0.05）。患者治疗前、治疗后1周、治疗后2周、治疗后3周及治疗后4周，上睑睑板腺分泌能力评分分别为（5.10±1.87）分、（3.90±1.30）分、（3.29±1.55）分、（3.38±1.66）分及（3.14±1.31）分；下睑评分分别为（4.57±1.99）分、（3.33±1.28）分、（2.90±1.51）分、（3.05±1.36）分及（2.38±1.07）分；上睑睑酯质量评分分别为（5.86±1.82）分、（4.76±1.41）分、（4.29±1.79）分、（3.81±1.36）分及（3.57±1.66）分；下睑评分分别为（5.19±2.14）分、（3.90±1.22）分、（3.43±1.47）分、（3.57±1.40）分及（3.38±1.43）分；荧光素泪膜破裂时间分别为（3.21±1.00）s、（3.73±0.82）s、（4.06±0.98）s、（4.62±1.38）s及（4.48±0.98）s；角膜荧光素染色评分分别为（4.76±2.72）分、（3.24±1.58）分、（2.90±1.70）分、（2.67±1.49）分及（2.33±1.53）分；不同时间上下睑睑板腺分泌能力、上下睑睑酯质量、荧光素泪膜破裂时间及角膜荧光素染色的比较，差异均有统计学意义（F＝5.552，6.440，6.559，4.867，6.239，5.393；P＜0.05）。治疗后第4周与治疗前上下睑睑板腺分泌能力、上下睑睑酯质量、荧光素泪膜破裂时间及角膜荧光素染色评分比较，差异有统计学意义（t＝-5.68，-6.42，-6.91，-4.67，6.02，-5.17；P＜0.05）。治疗后第4周与治疗前非接触泪膜破裂时间比较，差异有统计学意义（t＝2.12，P＜0.05）。治疗前、治疗后1周、治疗后2周、治疗后3周及治疗后4周非接触眼压分别为（13.19±2.79）mmHg（1 mmHg＝0.133 kPa）、（13.80±3.29）mmHg、（14.36±2.49）mmHg、（13.31±2.17）mmHg及（13.51±3.34）mmHg。眼前节和彩色眼底照相检查均未见明显变化及异常，患者眶周皮肤及毛发未见明显变化及异常且无特殊不适。

结论

使用射频技术治疗MGD相关干眼可改善患者的睑板腺分泌功能和泪膜稳定性，能有效地减轻患者的症状并改善相关体征，未发现不良反应。

Objective

The aim of this study is to investigate the safety and efficacy of radio frequency technique in the treatment of meibomian gland dysfunction（MGD）associated with dry eye.

Methods

A total of 21 patients（42 eyes）with MGD-related dry eye who visited the Ophthalmology Center of Beijing Tongren Hospital，Capital Medical University，from April 2024 and June 2024 were enrolled.Among them，7 were male（14 eyes）and 14 were female（28 eyes），with a mean age of（47.3±17.2）years（ranging from 23 to 73 years）.Each patient received bilateral eyelid radiofrequency treatment once per week for 20 minutes per session，for a total of four sessions.Non-contact intraocular pressure，anterior segment imaging，ocular surface disease index（OSDI）scores，symptom visual analog scale（VAS）scores，meibomian gland secretion grading，meibum quality scores，fluorescein tear film break-up time（FBUT），corneal fluorescein staining scores，and SchirmerⅠtest，best-corrected visual acuity，tear meniscus height（TMH），lipid layer thickness（LLT），and non-invasive tear break-up time（NITBUT）were assessed before treatment and post-treatment conformed normal distribution and presented as±s，and compared by ANOVA for intergroup，and compared by paired t-tests for changes in each parameter from baseline to the final follow-up.

Results

The OSDI scores for patients with MGD-related dry eye before treatment and at 1，2，3，and 4 weeks after treatment were（55.86±20.80）scores，（46.56±20.06）scores，（33.30±18.75）scores，（35.60±17.48）scores，and（25.99±11.15）scores，respectively.VAS scores for symptoms including burning or stinging，itching，foreign body sensation，dryness，photophobia，eye pain，and ocular discomfort were as follows：（47.71±22.71）scores，（42.90±23.28）scores，（35.57±19.82）scores，（31.86±19.49）scores，（28.67±17.83）scores，（46.95±20.12）scores，（45.95±21.89）scores，（34.05±16.02）scores，（31.14±21.90）scores，（22.95±15.57）scores，（53.57±25.48）scores，（48.48±22.22）scores，（36.43±19.23）scores，（35.76±21.89）scores，（22.48±12.71）scores，（65.67±27.58）scores，（55.90±23.22）scores，（43.76±22.99）scores，（37.86±18.79）scores，（28.90±14.22）scores，（53.71±21.57）scores，（45.57±23.25）scores，（36.38±23.47）scores，（29.05±18.28）scores，（21.10±12.66）scores，（53.86±20.82）scores，（44.55±19.23）scores，（31.71±17.87）scores，（33.50±16.98）scores，（24.71±10.87）scores，（70.67±17.84）scores，（51.90±20.77）scores，（39.52±21.52）scores，（34.10±18.23）scores，and（24.81±12.86）scores.The differences in OSDI and VASscores across time points were statistically significant（F＝9.103，2.958，5.870，7.211，9.334，8.457，9.103，19.340；P＜0.05）.By the 4^th week post-treatment，compared with baseline，the changes in OSDI and VAS scores for burning/stinging，itching，foreign body sensation，dryness，photophobia，eye pain，and discomfort had statistically significant（t＝-5.22，-8.43，-6.91，-7.85，-8.98，-9.32，-9.16，-13.85；P＜0.05）.The meibomian gland secretion scores（upper lid）at baseline and at 1，2，3，and 4 weeks posttreatment were（5.10±1.87）scores，（3.90±1.30）scores，（3.29±1.55）scores，（3.38±1.66）scores，and（3.14±1.31）scores；lower lid scores were（4.57±1.99）scores，（3.33±1.28）scores，（2.90±1.51）scores，（3.05±1.36）scores，and（2.38±1.07）scores.Meibum quality scores（upper lid）were（5.86±1.82）scores，（4.76±1.41）scores，（4.29±1.79）scores，（3.81±1.36）scores，and（3.57±1.66）scores；lower lid scores were（5.19±2.14）scores，（3.90±1.22）scores，（3.43±1.47）scores，（3.57±1.40）scores，and（3.38±1.43）scores.Fluorescein tear break-up times were（3.21±1.00）scores，（3.73±0.82）scores，（4.06±0.98）scores，（4.62±1.38）scores，and（4.48±0.98）seconds；corneal fluorescein staining scores were（4.76±2.72）scores，（3.24±1.58）scores，（2.90±1.70）scores，（2.67±1.49）scores，and（2.33±1.53）scores.These indicators showed significant differences over time（F＝5.552，6.440，6.559，4.867，6.239，5.393；P＜0.05）.By the 4^th week，compared to baseline，upper lid secretion，lower lid，upper lid meibum quality，lower lid，tear breakup time，and corneal staining had statistically significant the changes（t＝-5.68，-6.42，-6.91，-4.67，6.02，-5.17；P＜0.05）.There was a significant increase between before and after treatment in non-invasive tear break-up time（t＝2.12，P＜0.05）.Non-contact intraocular pressure at baseline，1，2，3，and 4 weeks post-treatment were（13.19±2.79）mmHg（1 mmHg＝0.133 kPa），（13.80±3.29）mmHg，（14.36±2.49）mmHg，（13.31±2.17）mmHg，and（13.51±3.34）mmHg，respectively.It has showed no notable abnormalities or changes in periocular skin or eyelashes，and no patients reported any specific discomfort.

Conclusions

The radio frequency technology had a capacity of improving the secretion function of meibomian gland and tear film stability，effectively alleviate the symptoms and improve the relevant signs of patients with dry eye associated with MGD，and non-adverse reactions.