Characterization and Prediction of the Clinical Outcome of Intense Pulsed Light-Based Treatment in Dry Eye Associated to Meibomian Gland Dysfunction

This non-comparative prospective case series was conducted to characterize the clinical impact of intense pulsed light (IPL)-based treatment in dry eyes associated to Meibomian gland dysfunction (MGD), defining the predicting factors for a successful outcome with this therapy in a large case series. A total of 390 eyes (195 patients, range: 23–93 years) received four sessions of Optima IPL system (Lumenis, Yokneam, Israel). Significant changes were observed in tear film osmolarity in both eyes (p < 0.001) and in meibum quality (p < 0.001), with more eyes showing clear or yellow secretions after therapy. Mean change in the ocular surface disease index (OSDI) was −8.61, ranging from −27.00 to 11.00. This change was significantly correlated with the baseline value of OSDI (r = −0.489, p < 0.001). The change in osmolarity correlated significantly with the baseline osmolarity in both eyes (right r = −0.636, left r = −0.620, p < 0.001). A linear predicting model of the change in OSDI with therapy was obtained: change OSDI = 10.99 − 0.35 × OSDI − 1.03 × NIBUTRE-LE (mean non-invasive break up time of right and left eye) −2.03 × Meibum quality grade (p = 0.001; R2: 0.325). In conclusion, the improvement in symptomatology achieved with an IPL-based therapy can be predicted at baseline using a linear model considering the level of MGD and the magnitude of OSDI and NIBUT (non-invasive break-up time).

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Ocular Surface Workup in Patients with Meibomian Gland Dysfunction Treated with Intense Regulated Pulsed Light

Diagnostics ◽

10.3390/diagnostics9040147 ◽

2019 ◽

Vol 9 (4) ◽

pp. 147 ◽

Cited By ~ 4

Author(s):

Luca Vigo ◽

Leonardo Taroni ◽

Federico Bernabei ◽

Marco Pellegrini ◽

Stefano Sebastiani ◽

...

Keyword(s):

Signs And Symptoms ◽

Meibomian Gland ◽

Response To Treatment ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Lipid Layer ◽

Non Invasive ◽

Lower Baseline ◽

Ocular Discomfort ◽

Break Up

The purpose of the present study was to evaluate changes of signs and symptoms in patients with meibomian gland dysfunction (MGD) treated with intense regulated pulsed light (IRPL), and to further investigate which parameter could predict positive outcomes of the procedure. Twenty-eight patients who bilaterally received three IRPL sessions at day 1, 15, and 45 satisfied the criteria and were included in the study. Non-invasive break-up time (NIBUT), lipid layer thickness (LLT), meibography, tear osmolarity, and ocular discomfort symptoms were measured before and 30 days after the last IRPL session. Qualified or complete success was defined in the presence of an improvement of symptoms associated with an increase of NIBUT (< or ≥ 20%). After IRPL treatment, median NIBUT and LLT increased from 7.5 to 10.2 s and 2.0 to 3.0, respectively (p <0.001); tear osmolarity decreased from 304.0 to 301.0 mOsm/L (p = 0.002). Subjective symptoms improved after IRPL in 26 patients. Qualified success was reached in 34 eyes, while complete success in 16 eyes. Patients with lower baseline break-up time (BUT) values showed better response to treatment (p = 0.04). In conclusion, IRPL improved signs and symptoms in MGD patients, while lower baseline NIBUT values were predictive of better response to IRPL.

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Intense pulsed light plus meibomian gland expression versus intense pulsed light alone for meibomian gland dysfunction: A randomized crossover study

PLoS ONE ◽

10.1371/journal.pone.0246245 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0246245

Author(s):

Kyoung Yoon Shin ◽

Dong Hui Lim ◽

Chan Hee Moon ◽

Byung Jin Kim ◽

Tae-Young Chung

Keyword(s):

Meibomian Gland ◽

Treatment Session ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

P Value ◽

Pulsed Light ◽

Ocular Surface Disease Index ◽

P Values ◽

Group 2 ◽

Group 1

Purpose To investigate the comparative efficacy of intense pulsed light (IPL) therapy alone with that of IPL plus meibomian gland expression (MGX) for meibomian gland dysfunction (MGD). Methods This is a prospective randomized crossover clinical trial. Sixty patients were enrolled and randomly assigned to two groups. All of patients underwent four treatment sessions in total, which were two weeks apart. Group 1 underwent two sessions of IPL therapy with MGX, as well as two sessions of IPL alone. Group 2 received two sessions of IPL therapy alone, and two sessions of IPL therapy with MGX. The following parameters were measured at baseline (BL), 2 weeks after the second treatment session (FU1), and 2 weeks after the fourth treatment session (FU2): tearfilm break-up time (BUT), Oxford grade for corneal staining, meibomian gland expressibility (MGE), meibum quality (MQ), and ocular surface disease index (OSDI). The separate effect of MGX on improvement of MGD parameters was evaluated using generalized estimating equation (GEE). Results The mean age of the participants was 57.52 ± 10.50 years. The BUT, Oxford grade, MGE, MQ, and OSDI of both groups improved significantly (from baseline) by the end of four treatment sessions (FU2 compared to BL; all p-values <0.05). The MGE and MQ significantly improved after the first and second treatment sessions (FU1 compare to BL; all p-values < 0.001). However, the improvement was not statistically significant after the third and fourth treatment sessions (FU2 compared to FU1; p-value of 0.388 for MGE and 0.645 for MQ in group 1, 0.333 for MGE and 0.333 for MQ in group 2). The IPL plus MGX therapy produced greater improvements in the BUT scores than did IPL therapy alone (p = 0.003 by GEE). In contrast, the Oxford grade, MGE, MQ, and OSDI were not influenced by the addition of MGX to IPL (p = 0.642, 0.663, 0.731, and 0.840, respectively by GEE). Conclusion IPL therapy effectively improves the subjective symptoms and objective ocular findings of MGD. MGX enhanced the improvement of BUT driven by IPL therapy. The meibomian gland function (MGE and MQ) recovers faster in response to IPL therapy than did the other parameters.

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Multicenter Study of Intense Pulsed Light for Patients with Refractory Aqueous-Deficient Dry Eye Accompanied by Mild Meibomian Gland Dysfunction

Journal of Clinical Medicine ◽

10.3390/jcm9113467 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3467

Author(s):

Reiko Arita ◽

Shima Fukuoka ◽

Takanori Mizoguchi ◽

Naoyuki Morishige

Keyword(s):

Dry Eye ◽

Tear Film ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Control Group ◽

Pulsed Light ◽

Lipid Layer ◽

Film Stability ◽

Schirmer’S Test

Aqueous-deficient dry eye (ADDE) and meibomian gland dysfunction (MGD) can be refractory to therapy. Intense pulsed light (IPL) was recently introduced as an effective treatment for MGD. We here evaluated the efficacy of IPL combined with MG expression (MGX) compared with MGX alone (n = 23 and 20, respectively) for patients with refractory ADDE with mild MGD at three sites. Symptom score, visual acuity (VA), noninvasive breakup time (NIBUT) and lipid layer thickness (LLT) of the tear film, lid margin abnormalities, fluorescein BUT (FBUT), fluorescein staining, tear meniscus height (TMH), meibum grade, meiboscore, and Schirmer’s test value were assessed at baseline and 1 and 3 months after treatment. LLT, plugging, vascularity, FBUT and NIBUT were improved only in the IPL-MGX group at three months compared with baseline. All parameters with the exception of VA, meiboscore, TMH, Schirmer’s test value were also improved in the IPL-MGX group compared with the control group at three months, as was VA in patients with central corneal epitheliopathy. Although IPL-MGX does not affect aqueous layer, the induced improvement in quality and quantity of the lipid layer may increase tear film stability and ameliorate symptoms not only for evaporative dry eye but for ADDE.

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Superficial keratectomy followed by intense pulsed light for Salzmann’s nodular degeneration and coexisting meibomian gland dysfunction

European Journal of Ophthalmology ◽

10.1177/1120672120964691 ◽

2020 ◽

pp. 112067212096469

Author(s):

Gaspare Monaco ◽

Giuseppe Casalino

Keyword(s):

Tear Film ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Blurred Vision ◽

Body Sensation ◽

Effective Option ◽

The Face ◽

One Year

Purpose: To describe the clinical course of a case of bilateral Salzmann nodular degeneration (SND) treated with superficial keratectomy (SK) followed by intense pulsed light (IPL) for the treatment of coexisting meibomian gland dysfunction (MGD). Case description: A 54-year-old man who presented to us complaining of progressive blurred vision associated with foreign body sensation in both eyes because of SND and coexisting MGD. In view of symptoms and visual acuity (VA) deterioration, bilateral SK was performed. Two months after SK, IPL treatment to the face and meibomian gland expression (MGX) using the E-eye device (E-SWIN, Paris) on days 0, 15, and 45, were performed in both eyes with the aim to avoid recurrence and/or progression of MGD. One year after SK, the patient was asymptomatic and VA was 20/20 in both eyes; however because of worsening of non-invasive tear film break-up time measured on Sirius® Scheimpflug tomograph, IPL and MGX were promptly repeated and scheduled every 6 months. Conclusion: In our case, IPL was a safe and effective option to control MGD in a patient with SND requiring SK with no observed recurrence of SND 2 years after surgery.

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Factors Influencing the Effectiveness of Intense Pulsed Light for Meibomian Gland Dysfunction

10.21203/rs.3.rs-52161/v1 ◽

2020 ◽

Author(s):

Chen Chen ◽

Di Chen ◽

Yu-yu Chou ◽

qin long

Keyword(s):

Influencing Factors ◽

Clinical Symptoms ◽

Influencing Factor ◽

Univariate Analysis ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Ocular Surface Disease Index ◽

Eyelid Margin

Abstract Purpose: To observe the effectiveness of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) and identify its influencing factors. Methods: Forty-eight eyes of 48 patients with MGD were included. Subjects were followed up 5 times and received IPL during the first three visits. Gender, age, duration of MGD, time of video display terminal usage, and severity of MGD were recorded at baseline. At every visit, Ocular Surface Disease Index (OSDI), eyelid margin abnormality score (EMAS), tear film breakup time (TBUT), Schirmer Ⅰ test (SⅠt) and corneal fluorescein staining (CFS) were recorded. The clinical parameters before and after 3 IPL treatments were compared. Univariate and multivariable logistic regression analyses were performed to explore influencing factors. Results: Compared with baseline, the TBUT was increased and the CFS score and OSDI were significantly decreased on day 45 and day 120 (all P < 0.001). In univariate analysis, among the patients with a younger age (18-39 years), moderate MGD, higher baseline SIt and higher baseline OSDI, the IPL treatment had a higher effective rate (P = 0.032, 0.004, 0.024 and 0.014 respectively). The MGD severity was strongly associated with effective IPL, and patients with moderate MGD had an OR of 5.493 compared with the severe MGD patients (OR = 22.454, 95% CI: 2.890-174.436, P = 0.003). Conclusions: IPL effectively improves clinical symptoms and some signs in MGD patients. Age, MGD severity, baseline SIt and baseline OSDI are potential factors that may influence the effectiveness of IPL. MGD severity is an independent influencing factor.

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Therapeutic Effect of Intense Pulsed Light (IPL) Combined with Meibomian Gland Expression (MGX) on Meibomian Gland Dysfunction (MGD)

Journal of Ophthalmology ◽

10.1155/2020/3684963 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Shanshan Wei ◽

Xiaotong Ren ◽

Yuexin Wang ◽

Yilin Chou ◽

Xuemin Li

Keyword(s):

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Ocular Surface Disease Index ◽

Eyelid Margin ◽

Assessment Scores ◽

Before And After ◽

Corneal Nerve

Purpose. Our study aimed to evaluate the efficiency of intense pulsed light (IPL) combined with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD). Methods. This study was a prospective interventional study. A total of 53 patients were included in the study and received a series of three treatments at an interval of 3-4 weeks. Follow-up examinations were completed 4 weeks after the last treatment. The Ocular Surface Disease Index (OSDI) questionnaire, tear meniscus height (TMH), tear break-up time (TBUT), slit-lamp examinations, and in vivo confocal microscopy (IVCM) were recorded before and after treatment. Additionally, an artificial intelligence automated software program was applied in our study for corneal nerve analysis. Results. The OSDI score was significantly reduced after the IPL treatment compared with baseline (P<0.001). Meibomian gland assessment scores, including meibum quality and expressibility, eyelid margin abnormalities, and corneal staining, significantly decreased after treatment (P<0.05). Moreover, the corneal nerve fiber length (CNFL) significantly increased after the treatment (P<0.001). Conclusion. Intense pulsed light (IPL) combined with MGX is an effective treatment for MGD, and neurotrophism could be one of the mechanisms of IPL.

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