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.