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

María T Iradier,Cristina Peris-Martínez,Priscilla Cedano,María Ángeles Del Buey,David P Piñero

doi:10.3390/jcm10163573

Abstract

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).

Highlights

Intense pulsed light (IPL) therapy has been used since many years ago in dermatology for the treatment of a great variety of conditions, including pigmented lesions, benign cavernous hemangiomas, telangectasias or facial rosacea [1]
A great variety of studies have been conducted to demonstrate the efficacy of IPL for the treatment of dry eye associated to Meibomian gland dysfunction (MGD) without [5,6,7,8,9,10,11,12,13,14,15,16] and with the combined meibomian gland expressibility (MGX) [17,18,19,20,21,22]
Other ocular therapeutic uses of IPL have been investigated in conditions such as the treatment of refractory aqueous-deficient dry eye accompanied by mild MGD [24], post-laser in situ keratomileusis (LASIK) dry eye [25,26], Demodex [27] or MGD in skin types III/IV [28]

Summary

Introduction

Intense pulsed light (IPL) therapy has been used since many years ago in dermatology for the treatment of a great variety of conditions, including pigmented lesions, benign cavernous hemangiomas, telangectasias or facial rosacea [1]. This process is repeated in 2–4 sessions [29] This irradiation of filtered polychromatic broad-bandwidth wavelengths with varying pulse durations generates various effects that contribute to its therapeutic properties: Meibomian glands warming that facilitates the expressibility and release of the meibum inside, improvement of the function of Meibomian glands, reduction of tear osmolarity, reduction of proinflammatory mediators contributing to dry eye, improvement of the cellular functions including fibroblasts regeneration, collagen synthesis, motility in immunoregulatory cells and photobiomodulation [15,30,31]. This is the largest series of cases reported to this date treated with an IPL-based protocol

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Discussion

Conclusion