Abstract
Purpose:To assess the effect of a novel intense pulsed light (IPL) therapy on tear proteins and lipids in eyes with Meibomian gland dysfunction (MGD).Methods:Twenty-four eyes of 12 patients with MGD were recruited and received five overlapping flashes (565-1400 nm) directed at the lower eyelid. The IPL parameters include intensity: 2.5 to 6.5 J/cm2, voltage: 100 to 240 V, frequency: 50 to 60 Hz, input: 16 W, maximum optical energy: 23 J, pulse duration: <2.0 ms, and repetition time: 1-3.5 s. Tear samples were evaluated immediately before and 2 weeks after IPL therapy and included measurements of protein concentration, electrophoretic mobility by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis, lipid profile assessments, and thin-layer chromatography (TLC) for phospholipids.Results:Significant improvements were observed in tear protein concentrations and molecular weight after IPL therapy. The most pronounced effect was in the molecular weight of tear lysozyme, lactoferrin, and albumin. Tear lipids showed an improvement in the concentrations of total lipids, triglycerides, cholesterol, and phospholipids. On TLC, the tears in patients with MGD had significantly lower amounts of anionic phosphatidylethanolamine, phosphatidylinositol, and phosphatidylserine but amounts zwitterionic neutral phospholipid phosphatidylcholine were normal. These anionic phospholipids showed obvious recovery after IPL therapy.Conclusion:IPL therapy is effective in eyes with MGD. It improved tear protein and lipid content and composition. The anionic phospholipids were more responsive to IPL therapy than were the other zwitterionic phospholipids.
Highlights
Meibomian gland dysfunction (MGD) is one of the most common causes of dry eye.[1]
The participated subjects (24 subjects) in this study were divided into two groups: (a) control group (12 subject, 50%, 24 eyes) was selected from the work place in our institute and (b) MGD group (12 subject, 50%, 24 eyes)
Tear cholesterol concentration was 3.99 ± 0.54 mg/ml in the controls and significantly reduced to 3.27 ± 0.06 (P < 0.01) and 3.65 ± 0.05 mg/ml (P < 0.05) in patients before and after intense pulsed light (IPL) therapy, respectively, with percentage decreases of 18.11% and 8.41% compared to the controls
Summary
Meibomian gland dysfunction (MGD) is one of the most common causes of dry eye.[1] It is a diffuse malfunction of the Meibomian glands, whose terminal duct is completely or partially obstructed. The glandular secretion changes in quality or/and quantity, resulting in an unstable tear film.[1] Its main signs range from dryness, eye irritation, foreign body sensation, burning, watering, and fatigue.[2] Its occurrence fluctuates worldwide, from 3.5% to nearly 70%, and this makes scientists and clinical doctors anxious.[3]. The obstruction occurs when the terminal duct is filled with thickened meibum, which comprises keratinized cell material, resulting in intraglandular cystic dilation, gland failure, and low secretion.[1] Decreased meibum outflow increases the production and release of fatty acids, monoglycerides, and diglycerides by commensal bacteria into the tear film, thereby triggering irritation.[4,5]
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