Une nouvelle étude en faveur de l'efficacité de la lumière pulsée dans le traitement de l'oeil sec: 4 ou 5 séances peuvent être recommandées
Ocul Surf. 2020 Jan 30. pii: S1542-0124(20)30018-5. doi: 10.1016/j.jtos.2020.01.003. [Epub ahead of print]
Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction.
To assess long-term cumulative treatment effects of intense pulsed light (IPL) therapy in meibomian gland dysfunction (MGD).
Eighty-seven symptomatic participants (58 female, mean±SD age, 53±16 years) with clinical signs of MGD were enrolled in a prospective, double-masked, parallel-group, randomised, placebo-controlled trial. Participants were randomised to receive either four or five homogeneously sequenced light pulses or placebo treatment to both eyes, (E-Eye Intense Regulated Pulsed Light, E-Swin, France). Visual acuity, dry eye symptomology, tear film parameters, and ocular surface characteristics were assessed immediately before treatment on days 0, 15, 45, 75, and four weeks after treatment course completion on day 105. Inflammatory and goblet cell function marker expression, and eyelid swab microbiology cultures were evaluated at baseline and day 105.
Significant decreases in OSDI, SPEED, and SANDE symptomology scores, and meibomian gland capping, accompanied by increased tear film lipid layer thickness, and inhibited Corynebacterium macginleyi growth were observed in both treatment groups (all p<0.05). Sustained clinical improvements occurred in both treatment groups from day 75, although significant changes from day 45, in lipid layer quality, meibomian gland capping, OSDI and SANDE symptomology, were limited to the five-flash group (all p<0.05).
IPL therapy effected significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients. Five-flash IPL treatment showed superior clinical efficacy to four-flash, and an initial course of at least four treatments is suggested to allow for establishment of sustained cumulative therapeutic benefits prior to evaluation of overall treatment efficacy.
Can J Ophthalmol. 2020 Jan 13.
Intense Pulsed Light Therapy with Meibomian Gland Expression for Dry Eye Disease.
To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye symptoms.
Systematic Review followed by a meta-analysis.
Not applicable METHODS: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Literature sources included MEDLINE, Embase, Cochrane Library, and meeting abstracts from Canadian Ophthalmological Society, The Association for Research in Vision and Ophthalmology, The American Academy of Ophthalmology, and The European Society for Cataract and Refractive Surgeons. Articles underwent 3 stages of screening before data extraction and meta-analysis.
After the initial search, 502 studies were found. Six articles were included for meta-analysis, and data were extracted after 3 stages of screening. Meta-analysis indicated significant increase in tear break-up time (TBUT) post-treatment in the <1-month follow-up (standardized mean difference [SMD] = 1.29; confidence interval [CI]: 1.10-1.48), up-to-6-month follow-up (SMD = 1.71; CI: 1.46-1.96), and >6-month follow-up (SMD = 2.04; CI: 1.68-2.40) groups. Moreover, meta-analysis suggested a nonsignificant improvement in Standardized Patient Evaluation of Eye Dryness (SPEED) scores after IPL with MGX at the <1-month follow-up (SMD = -1.35; CI: -1.70 to -1.01), up-to-6-month follow-up (SMD = -1.68; CI: -1.93 to -1.43), and >6-month follow-up (SMD = -2.04; CI: -2.40 to -1.68) groups. Meta-analysis also indicated a nonsignificant improvement in Schirmer's test values at the up-to-2-month follow-up (SMD = -0.27; CI: -0.66 to 0.12), up-to-6-month follow-up (SMD = 0.04; CI: -0.25 to 0.33), and >6-month follow-up (SMD = -0.01; CI: -0.31 to 0.28) groups.
The results suggested a significant increase in TBUT and a nonsignificant increase in SPEED and Schirmer's test values at all follow-up periods post-treatment. Ultimately, IPL with MGX appears to be a promising therapy for MGD.
Int Ophthalmol. 2020 Jan 8.
Intense pulse light therapy treatment for refractory dry eye disease due to meibomian gland dysfunction.
To assess the effect of the intense pulse light (IPL) therapy for the treatment of meibomian gland dysfunction (MGD) and dry eye parameters.
Patients who underwent an IPL therapy for the treatment of MGD were included in this retrospective study. Ocular Surface Disease Index (OSDI) scores, the frequency of daily lubricant use, non-invasive tear break-up time (NIBUT), meibomian glad dropout scores, corneal staining scores, and Schirmer test results were collected from patient charts that recorded at baseline and follow-up visits at 1 month, 3 months, and 12 months. For the analysis, patients were grouped based on the severity of their baseline meibomian gland dropout score as mild, moderate, and severe atrophy.
Forty-three patients (mild atrophy = 22, moderate atrophy = 17, and severe atrophy = 4) were included for analysis. Except for the Schirmer test, all dry eye parameters significantly improved in patients with mild and moderate atrophy following the treatment and this effect lasted until the 12-month follow-up visit (p < 0.001). No significant improvement in any parameter was observed in patients with severe atrophy at any time point (p > 0.05). In the mild and moderate atrophy groups, OSDI scores, as well as NIBUT, started improving at 1 month (p < 0.01), while corneal staining and meibomian gland dropout scores showed earliest improvements at 3 months (p < 0.01). No adverse events were observed, except for temporary redness in 4 patients.
The IPL treatment seems an effective and safe treatment for patients with MGD. This study shows that the IPL resulting in an earlier improvement in symptoms and signs with long-lasting beneficial effect on the meibomian glands.
Efficacité de la lumière pulsée sur le traitement du demodex
Photobiomodul Photomed Laser Surg. 2020 Jan 27. doi: 10.1089/photob.2019.4737. [Epub ahead of print]
Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light.
Objective: To directly observe the in vitro real-time effects of intense pulsed light (IPL) on a Demodex mite extracted from an eyelash of a patient with ocular rosacea. Background: Demodex is a risk factor in the pathogenesis of oculofacial rosacea, meibomian gland dysfunction (MGD), and dry eye disease (DED). Recent studies suggested IPL to control or eradicate Demodex organisms in the periocular area. Despite encouraging reports, the direct effect of IPL on Demodex is not well understood. Methods: An eyelash infested with Demodex was epilated from a 62-year-old female patient with oculofacial rosacea. Following isolation and adherence of a mite onto a microscope slide, real-time video microscopy was used to capture live images of the organism before, during, and after administration of IPL pulses. IPL pulses were delivered with the M22 IPL (Lumenis), with IPL settings used for treatment of DED due to MGD (the "Toyos protocol"). A noncontact digital laser infrared thermometer was used to measure the temperature of the slide. Results: Before the IPL pulses, legs of the Demodex mite spontaneously moved in a repetitive and semicircular motion. During administration of IPL, spontaneous movements of the legs continued. Immediately after administration of five IPL pulses, the temperature of the slide increased from room temperature to 49°C. Immediately afterward, the Demodex mite became completely immobilized. The legs appeared retracted, smoother, less corrugated, bulkier, and less well-defined. Movement of the Demodex mite was not observed at the hourly inspections for 5 h and after 24 h following the application of IPL pulses. Conclusions: Our video directly demonstrates the effect of IPL on a live Demodex mite extracted from a freshly epilated eyelash. The results suggest that IPL application with settings identical to those used for treatment of DED due to MGD causes a complete destruction of the organism.