Efficacy and Clinical Outcome of Single and Combined Therapies for Refractory Meibomian Gland Dysfunction: Probing, Intense Pulsed Light, and Thermal Pulsation Treatments

Abstract

Background: Refractory meibomian gland dysfunction (MGD) is a prevalent condition characterized by chronic functional abnormalities of the meibomian glands, leading to altered tear film and ocular discomfort despite medical treatments. Traditional management strategies include various single-modality treatments, although there is growing interest in the efficacy of combined therapies. Aim: The aim of this study was to evaluate the efficacy of regimens used individually and in combination for the treatment of refractory MGD. Methods: This retrospective study involved pre- and posttreatment evaluations of the ocular surface and symptoms in patients with refractory MGD. Treatments included meibomian gland probing (MGP), intense pulsed light (IPL) therapy, thermal pulsation (LipiFlow), IPL + MGP, and MGP + LipiFlow. Results: In total, 325 eyes of 241 patients with refractory MGD were assessed. The MGP group showed significant improvements in the ocular surface disease index (OSDI), tear meniscus height (TMH), corneal and conjunctival staining, lid wiper epitheliopathy (LWE), and meibomian gland expression (MGX) score. The IPL group showed significant improvements in OSDI, TMH, redness, conjunctival staining, and MGX score. IPL + MGP resulted in significant improvements in corneal and conjunctival staining, LWE, and MGX score, while LipiFlow significantly improved conjunctival staining, LWE, and MGX score. No significant improvements were observed in the MGP + LipiFlow group. Conclusion: IPL or MGP alone could alleviate the signs and symptoms of refractory MGD, while LipiFlow and IPL + MGP could improve the ocular surface parameters. However, no significant improvements were observed with MGP + LipiFlow. These findings provide a valuable guide for ophthalmologists for the selection of effective treatment modalities for refractory MGD, suggesting a potential advantage of combined IPL + MGP to maximize therapeutic benefits.