| BackgroundMeibomian gland dysfunction (meibomian gland dysfunction, MGD) is a relatively common form of chronic eye disease.Its incidence was getting younger and younger, increasingly high incidence of symptoms of varying severity, and can seriously affect the quality of life of patients. Meibomian gland dysfunction is mainly meibomian gland function abnormal, causing a series of physiological and pathological changes, Including meibomian gland morphology and physiological function changes. Over the years, researchers have been committed MGD ophthalmology research, in terms of basic research level or clinical science, there has been great progress. Foundations, from the micro-structural abnormalities to microbiology and biochemistry, lipid composition analysis, medical physics, neurohumoral regulation, hormone secretion, a variety of inflammatory cytokines, which have an in-depth analysis. From the recent information and documentation can be seen, although studies from different levels, but there are problems in the following areas still not been solved. The first is the cause, the cause of many of them, some still in the speculation stage, it did not have been widely recognized. The second is the relationship between MGD and other diseases remains unclear, such as MGD associated with diabetes, hypertension, hyperlipidemia whether there is a correlation, or there is any relationship between each other and other issues still need further study. MGD tertiary treatment is not highly specific drugs. There have been reports of dermatitis, when there is a change cataracts, glaucoma and other eye diseases levels of certain inflammatory factors, and tissue prostaglandin E2 content of change. MGD clinical manifestations are redness, itching, foreign body sensation, dryness, etc., the symptoms of clinical manifestations in parts of the body similar to the effect of PGE2. Therefore, we hypothesized that PGE2 and MGD close. After checking the literature found very few studies have reported on MGD meibomian gland secretions and tears and PGE2 in terms of relevance.Bromfenac Sodium Hydrate Ophthalmic Solution is a non-steroidal anti-inflammatory drugs, mainly inhibit the biosynthesis of PG and relieve inflammation.Disease lesions of fibrous tissue proliferation, inhibition of angiogenesis, reduce inflammation and edema, so the inflammation caused by PG curative. The major components of the general monogram drops bromfenac sodium hydrate. Bromfenac sodium is a non-steroidal anti-inflammatory drugs, anti-inflammatory, analgesic, antipyretic effect. Its mechanism of action is through inhibition of prostaglandin synthesis enzyme function, its analgesic effect belong to the outer periphery of the non-narcotic analgesic effect. The drug is mainly used to treat some inflammatory ophthalmic diseases, such as anterior uveitis, conjunctivitis, and after intraocular surgery, such as cataract surgery obstruction. According to the etiology of MGD has increased production induced by prostaglandin-induced, and the general nanogram drops by inhibiting prostaglandin synthetase reduced tissue PGE2 content, thereby reducing the symptoms of MGD. After checking the literature found that there are few reports of clinical drug efficacy using the general treatment of MGD analysis.MGD can be divided into the secretion of excessive type and the secretion of too lillle type. This study aimed to the secretion of excessive type of MGD to expand.ObjectiveThis study was designed to detect the content of PGE2 in meibomian gland secretion and tear in patients with varying degrees of MGD, so as to explore the role of PGE2 in MGD and MGD seek treatment more targeted medicines and appropriate treatment modalities.Methods1.Research SubjectsThe first part of the collection from January 2014 to December 2015 at the eye clinic diagnosis of MGD and informed consent of patients experiment with 72 cases (120 eyes) included in the experimental group, the experimental group composite score based on the respective slit lamp examination of the grading standards after 36 patients were divided into mild to moderate (60 eyes) and severe group of 36 patients (60 eyes).30 cases of healthy adults (60 eyes) as the control group. This part is detected in each group tears and meibomian gland secretions of PGE2 (healthy individuals does not collect meibomian gland secretions).The second part of the collection from January 2014 to December 2015 at the eye clinic diagnosis of MGD and informed consent of the experiment with 60 patients (120 eyes), based on composite score for each slit lamp examination of the grading standards are divided into light moderate group and severe group, two groups were set up in the experimental group and control group. Mild to moderate group of 30 patients (60 eyes),15 patients (30 eyes)in the control group,15 cases(30 eyes) of the experimental group.Severe group of 30 patients (60 eyes),16 patients (32 eyes)in the control group and 14 patients (28 eyes) in the experimental group. This section observe the clinical curative effect of the Bromfenac Sodium Hydrate Ophthalmic Solution..2.DiagnosisDiagnosis of meibomian gland dysfunction has not been a consistent international accepted diagnostic criteria, mainly by conventional diagnostic methods to find missing meibomian glands, eyelid opening inconsistent or meibomian gland secretions status (including the number of and quality) abnormal symptoms when combined with other signs, can be diagnosed as meibomian gland dysfunction.3.Rating and grouping criteriaAfter the project from the slit lamp examination scores were obtained by adding the scores of the grouping. Slit lamp examination items and scoring criteria:(1) Pressing the Meibomian glands, central evaluate lower eyelid gland secretions discharged five degrees of difficulty, according to meibomian gland lipid discharge situations rating:All gland secretions are 3 points out of 3 to 4 gland secretions out of 2 points,1 to 2 out of glandular secretions of 1 minute, no glandular secretions all out to zero, and the total points 3 points. (2) Observation of meibomian gland secretions traits, normal eyelid fat clear, transparent and 0 points,1 point eyelid fat dirty, dirty eyelid fat chips or particles with 2 points, eyelid fat was thick toothpaste-like 3 points, score 3 points. (3) Sodium fluorescein corneal staining, using 0-3 point scale method for recording staining the cornea is divided into four quadrants, each area is divided according to the degree of staining and 0 to 0.75 points.0 no staining,<5 point scoring 0.25 points,≥5 points is 0.5 points,≥5 points and a massive stain or filamentous count as 0.75 points, score 3 points. Each test item total score total score of 9 points.0-3 is divided into mild, moderate divided into 4 to 6,7 to 9 minutes and severe. According to the total score were divided into mild and moderate group and severe group (because previous studies showed mild group, moderate group tears of PGE2 was no significant difference, it is combined into one group design).4.Exclusion criteria(1) Within the past three months there have been acute eye infection symptoms. (2) The eye allergy symptoms. (3) Encountered other reasons such as chemical injuries, thermal burns caused by ocular surface diseases. (4) 6 purposes of intraocular or extraocular surgery within months, within (5) A month received prostaglandin inhibitory drugs. (6) Failure to set out a number of other systemic or ocular tissue can affect the level of prostate case.5.Meibomian gland secretions and tears specimen collectionCollecting informed consent with the experimental patients with MGD of meibomian gland secretions and tear and normal human tear. Meibomian secretion collection methods:take seat, natural binocular smooth inspect, slit lamp microscope assisted, the use of cotton rod double extrusion method. Extrusion secretion using tears flushing needle scraping swab, specimen seal stored in 80℃. Tear collection methods:sitting relaxed, the rotary eye natural, with glass capillary tube from 20 microliters of fornical acquisition tear -80℃ preservation, directly for the determination of PGE2.The use of different groups of adsorption tears and meibomian gland secretions content test for detection of PGE2 enzyme immunoassay.7.TreatmentMild to moderate group in the control group in the first two weeks are used tobramycin eye ointment, eye drops hydroxyl glycoside. mild to moderate group in the experimental group in the control group based on the use of general ng drops liquid. Severe group in the control group in the first week using tobradex eye ointment, eye drops hydroxyl glycoside, the second week of the use of tobramycin eye ointment, eye drops hydroxyl glycoside. severe group experimental group received the control group on the basis of ng with the general eye drops.8.Efficacy Evaluation SystemCourse of the study, we developed a general ng eyedrops MGD efficacy evaluation indicators:OSDI symptom score, sodium fluorescein corneal staining, tear film breakup time, Schirmer test. Respectively, before treatment,1 week after treatment, after two weeks of treatment efficacy evaluation index score.9.Statistical analysisUsing SPSS21.0 statistical package for data analysis. First analysis of variance were compared meibomian gland secretions and tears PGE2 whether there are differences among the three groups, if there are differences, then LSD-t test between the two groups were compared using Pearson linear correlation analysis and tear secretion PGE2 content relevance, count data using t test, P<0.05 was considered statistically significant.Results1.The first partial results(1) The content of PGE2 in tear was statistically significant difference between the three groups (F=100.26, P<0.001); (2) Severe group tear PGE2 was higher than that of mild to moderate group (t=5.789, P< 0.001) and normal group (t=7.468, P< 0.001); (3) There was no significant difference between mild and moderate patients the content of PGE2 and the normal group (t=0.923, P> 0.05); (4) The content of PGE2 in meibomian gland secretions between the three groups was statistically significant, severe group was higher than that of mild to moderate group (F=151.76, P<0.001); (5) Severe group content of PGE2 was positively related with tear secretion (r= 0.71, P<0.001); (6) Patients with mild to moderate meibomian gland secretions PGE2 content was positively correlated (r=0.30, P<0.05)2.The second part of the results(1) Before treatment of mild to moderate experimental and control groups was not statistically significant (P> 0.05). (2) The treatment of mild to moderate group 1 week experimental group OSDI symptom score, tear film breakup time and Schirmer tests than the control group, the difference was statistically significant (P<0.05). (3) After 2 weeks of treatment of mild to moderate group, the experimental group OSDI symptom score, tear film breakup time and Schirmer test than the control group, the difference was statistically significant (P<0.05). (4) Severe group before treatment experimental group and control group was not statistically significant (P> 0.05). (5) After the severe group 1-week treatment in the experimental group OSDI symptom score, tear film breakup time and Schirmer test than the control group, the difference was statistically significant (P<0.05). (6) Severe degree group 2 weeks of treatment, the experimental group OSDI symptom score, tear film breakup time and Schirmer test than the control group, the difference statistically significant (P<0.05). (7) The experimental group and the control group of the mild to moderate group and severe group at 1 weeks after treatment,2 weeks after the treatment of patients with corneal fluorescence staining, the difference was not statistically significant (P> 0.05)Conclusion(1) The content of PGE2 in tears of patients with MGD is higher than normal; (2) The content of PGE2 in meibomian gland secretion is related to the degree of severity of MGD; (3) PGE2 in MGD occurred plays an important role in the development process; (4) Meibomian secretion and tear PGE2 level anomaly diagnosis for MGD; (5) MGD meibomian gland secretion and tear PGE2 content was positively related; (6) The prostaglandin synthetase inhibitor proletarian as the Bromfenac Sodium Hydrate Ophthalmic Solution eye drops Play a role in MGD. |
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