Meibum Expressibility Improvement as a Therapeutic Target of Intense Pulsed Light Treatment in Meibomian Gland Dysfunction and Its Association with Tear Inflammatory Cytokines

Mutlaq Hamad Alotaibi,Young Joon Choi,Yong Woo Ji,Sang Min Nam,Soo Jung Han,Eung Kweon Kim,Ikhyun Jun,Kyoung Yul Seo,Moonjung Choi,Byung Yi Ko,Tae-Im Kim

doi:10.1038/s41598-019-44000-0

Abstract

Many recent studies have demonstrated the efficacy of intense pulsed light (IPL) for the treatment of meibomian gland dysfunction (MGD); however, its effective treatment targets have not yet been elucidated. This study aimed to investigate the baseline characteristics associated with an improvement in symptoms after IPL treatment; to examine the course of change in inflammatory tear cytokines, meibomian gland function, and tear stability; and to investigate the correlation between cytokines and ocular surface parameters. Thirty participants underwent three sessions of IPL treatment. During each examination, tear film lipid layer interferometry, meibography, tear meniscus height measurement, tear sampling, and slit-lamp examination were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Meibum quality, meibum expressibility, lid margin abnormality, tear film break-up time (TBUT), ocular surface staining, and the OSDI significantly improved after treatment. Poor meibum expressibility and short TBUT were associated with greater recovery in the OSDI after IPL. Tear levels of IL-4, IL-6, IL-10, IL-17A, and TNF-α decreased after IPL, and IL-6, and TNF-α were correlated with the improvement in meibum expressibility. Therefore, IPL treatment improved meibomian gland function, stabilized the tear film, and decreased ocular surface inflammation. Patients with obstructive MGD and tear instability were more likely to experience an improvement in ocular discomfort after IPL treatment.

Highlights

The subjects had moderate to severe MGD according to the clinical signs of MGD and accompanying severe dry eye disease (DED) in terms of a short tear break-up time (TBUT) and high Ocular Surface Disease Index (OSDI) score
Among the clinical parameters that responded to intense pulsed light (IPL) treatment (Fig. 1), meibum expressibility showed the strongest relationship with the improvement in the OSDI score when other parameters were statistically controlled (Table 1)
Meibum expressibility correlated with multiple inflammatory tear cytokines, IL-6 and TNF-α, whose levels were shown to decrease with IPL treatment (Figs 2 and 3)

Summary

Introduction

Tear cytokines have been reported to be elevated in dry eye and MGD, and to be correlated with symptoms and clinical parameters[16,17]. A serial evaluation of the changes in tear cytokine levels and clinical assessment throughout the sequential treatment period would help explain the anti-inflammatory effect of IPL, as well as in determining the correlation between inflammation and the clinical outcome. A recent study showed that IPL treatment can reduce the levels of tear inflammatory markers IL-17A and IL-6 in patients with MGD18. The proposed anti-inflammatory effect of IPL was further investigated by analyzing additional tear inflammatory cytokines other than those previously evaluated.

Objectives

Results

Conclusion