Intense Pulsed Light Therapy with Optimal Pulse Technology as an Adjunct Therapy for Moderate to Severe Blepharitis-Associated Keratoconjunctivitis.

Fang Ruan,Ying Jie,Zhiqiang Pan,Yunxiao Zang,Natalie A. Afshari,Ruti Sella,Shang Li,Ke Yang,Tao Jin,Hongshuang Lu

doi:10.1155/2019/3143469

Abstract

Purpose To evaluate the intense pulsed light (IPL) therapy with optimal pulse technology (OPT, M22™, Lumenis, USA) as an adjunct therapy for the prevention of recurrences in moderate to severe blepharokeratoconjunctivitis (BKC). Methods This open-label nonrandomized clinical trial evaluated 33 patients diagnosed with BKC. Twenty-one patients received four bilateral OPT therapy sessions with Meibomian gland expression (MGX) (treatment group), and 11 patients received MGX alone (controls). This trial was initiated after a four-week pharmacotherapy for BKC in both groups and was scheduled at four-week intervals. Efficacy outcome measures included meibum quality, Meibomian gland (MG) secretion function, eyelid margin signs, corneal fluorescein staining (CFS) score, noninvasive keratography breakup time (NIKBUT), ocular surface disease index (OSDI) score, Schirmer I test (SIT), classification of tear film lipid layer (TFLL), and Meibomian gland dropout (MGDR). Safety outcome measures included visual acuity, intraocular pressure, eye structure damage, and facial skin appearance at each visit. Results Quality of meibum, MG expressibility, eyelid margin signs, and OSDI score showed a statistically significant greater improvement in the treatment group after one to three treatment sessions, compared to controls (p < 0.05). While these improved in both groups in comparison to baseline, the NIKBUT and upper and lower eyelid MGDRs significantly improved only in the treatment group (p < 0.05). No adverse events occurred in both groups. No BKC recurrences were noted in the treatment group. Conclusions IPL is a safe and effective adjuvant treatment for BKC and possibly more effective in reducing eyelid margin inflammation and prevents recurrences than MGX alone. This trial is registered with ChiCTR-ONN-17013864.

Highlights

Blepharitis is a common subacute or chronic inflammation affecting bilateral eyelid margins’ skin and mucosa, eyelash follicles, and other adnexal glands
The keratoconjunctivitis was first controlled with topical eye drops for one month, and the OPT combined with Meibomian gland expression (MGX) or MGX therapy alone were individually suggested
E beneficial effect of IPL as a treatment modality for MGD has been previously reported, with significant improvement in tear film lipid layer (TFLL), BUT, subjective symptom scores, and eyelid margin signs, especially for those with refractory MGD [22,23,24,25,26]. e pivotal mechanism behind IPL with OPT is the induction of selective photothermolysis of oxyhemoglobin of the yellow light, transforming luminous energy into heat energy, enabling coagulation and ablation of abnormal capillaries which decreases the dissemination of inflammatory factors [6, 27]. is is seen in its effect over various diseases, including rosacea [5]

Summary

Introduction

Blepharitis is a common subacute or chronic inflammation affecting bilateral eyelid margins’ skin and mucosa, eyelash follicles, and other adnexal glands. When this chronic inflammatory disease of the palpebral margin is complicated with secondary conjunctivitis and keratopathy, it is clinically referred to as blepharokeratoconjunctivitis (BKC) [1]. As physicians noticed a consequent improvement of their patients’ dry eye symptoms, they started assessing the theoretical mechanisms of IPL treatment for MGD and concluded that the treatment may cause selective photothermolysis and reduction of bacteria and/or parasitic growth and provide a temporary local warming effect [10, 11]. IPL is an emerging treatment option for patients with evaporative dry eye disease

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Results

Conclusion