Ocular Surface Workup in Patients with Meibomian Gland Dysfunction Treated with Intense Regulated Pulsed Light.

Luca Vigo,Nicola Di Stefano,Andrea Mercanti,Federico Bernabei,Leonardo Taroni,Francesco Carones,Giuseppe Giannaccare,Marco Pellegrini,Vincenzo Scorcia,Stefano Sebastiani

doi:10.3390/diagnostics9040147

Luca Vigo, Nicola Di Stefano + Show 8 more

Open Access

https://doi.org/10.3390/diagnostics9040147

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Abstract

The purpose of the present study was to evaluate changes of signs and symptoms in patients with meibomian gland dysfunction (MGD) treated with intense regulated pulsed light (IRPL), and to further investigate which parameter could predict positive outcomes of the procedure. Twenty-eight patients who bilaterally received three IRPL sessions at day 1, 15, and 45 satisfied the criteria and were included in the study. Non-invasive break-up time (NIBUT), lipid layer thickness (LLT), meibography, tear osmolarity, and ocular discomfort symptoms were measured before and 30 days after the last IRPL session. Qualified or complete success was defined in the presence of an improvement of symptoms associated with an increase of NIBUT (< or ≥ 20%). After IRPL treatment, median NIBUT and LLT increased from 7.5 to 10.2 s and 2.0 to 3.0, respectively (p <0.001); tear osmolarity decreased from 304.0 to 301.0 mOsm/L (p = 0.002). Subjective symptoms improved after IRPL in 26 patients. Qualified success was reached in 34 eyes, while complete success in 16 eyes. Patients with lower baseline break-up time (BUT) values showed better response to treatment (p = 0.04). In conclusion, IRPL improved signs and symptoms in MGD patients, while lower baseline NIBUT values were predictive of better response to IRPL.

Highlights

Dry eye symptoms are among the most common complaints at ophthalmic practices, impairing patient quality of life and restricting daily activities and work productivity [1,2]
Various ocular and systemic conditions can determine the onset of dry eye [3,4,5,6], the vast majority of cases originates from a deficiency of the meibomian glands, that is characterized by a chronic and diffuse abnormality of glands with obstruction of terminal duct and qualitative/quantitative changes of glandular secretion [7,8]
The pathogenesis of meibomian gland dysfunction (MGD) is arranged in a vicious circle: meibomian gland inflammation or blockage for ductal epithelium hyperkeratinization leads to stasis of the meibum inside the glands

Summary

Introduction

Dry eye symptoms are among the most common complaints at ophthalmic practices, impairing patient quality of life and restricting daily activities and work productivity [1,2]. Various ocular and systemic conditions can determine the onset of dry eye [3,4,5,6], the vast majority of cases originates from a deficiency of the meibomian glands (meibomian gland dysfunction, MGD), that is characterized by a chronic and diffuse abnormality of glands with obstruction of terminal duct and qualitative/quantitative changes of glandular secretion [7,8]. The pathogenesis of MGD is arranged in a vicious circle: meibomian gland inflammation or blockage for ductal epithelium hyperkeratinization leads to stasis of the meibum inside the glands. Diagnostics 2019, 9, 147 meibum and resulting in further blockage of the gland orifices [9]. Therapy often provides only short-term and partial relief of symptoms and signs, with compliance issues

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