Intraductal Meibomian Gland Probing Research Articles

Review of Literature on Intraductal Meibomian Gland Probing with Insights from the Inventor and Developer: Fundamental Concepts and Misconceptions.

Obstructive Meibomian gland dysfunction (MGD) affects millions of patients around the world. Its effective treatment with intraductal meibomian gland probing (MGP), was first reported in 2010. Since then, MGP has provided relief to thousands of patients globally suffering with refractory MGD. The purpose of Meibomian gland probing is restoring the integrity of the gland's central duct by entering the gland through the natural orifice, releasing fixed obstruction thought to be periductal fibrosis, thereby establishing and/or confirming the patency of the duct, and concurrently equilibrating intraductal pressure as well as promoting gland functionality with meibum production. There may or may not be immediate secretion of meibum upon successful restoration of ductal integrity depending on the gland's state of function and degree of atrophy. One double-blind placebo-controlled study has been conducted and, with the accumulated evidence of over 12 other peer reviewed articles in the scientific literature, overwhelmingly indicates that MGP is a safe and effective treatment for the MGD patient refractory to prior standard care and as a first-line treatment. This paper describes relevant fundamental concepts, dispels commonly held misconceptions, and provides an objective review of the current understanding and effectiveness of MGP for the treatment of obstructive MGD. Our analysis will better equip clinicians to draw informed conclusions about both subjective and objective findings reported in MGP studies and researchers to design future robust studies that provide meaningful results.

Latest evidences on meibomian gland dysfunction diagnosis and management

Meibomian gland dysfunction (MGD) can be considered the leading cause of dry eye disease (DED) and one of the most common ophthalmic disorders found in clinical practice. The growing body of literature provides a substantial amount of information on this condition, but more efforts are needed to better interpret research data and to properly apply them to daily clinical practice., In this article, we reviewed the most recent publications on MGD diagnosis and management, focusing on the highest available level of evidence, provided by well-designed and well-reported studies on humans., Latest evidences on MGD diagnosis are mainly focused on imaging techniques, including meibography, optical coherence tomography (OCT), and in vivo confocal microscopy. Meibographic parameters, such as drop-out and glands’ distortion, show great diagnostic accuracy, which accounts for their widespread use in clinical practice and research., Recent randomized controlled clinical trials on MGD treatment provided data on the role of antibiotics, steroids, essential fatty acids, intraductal meibomian gland probing, electronic heating devices and intense pulsed light therapy.

A randomized, sham-controlled trial of intraductal meibomian gland probing with or without topical antibiotic/steroid for obstructive meibomian gland dysfunction

ImportanceObstructive meibomian gland dysfunction (MGD) can be refractory to medical therapy. Intraductal meibomian gland (MG) probing may offer a potential therapeutic approach for these patients, but no randomized trials have been conducted to date. ObjectiveTo assess clinical changes after intraductal MG probing for patients with refractory obstructive meibomian gland dysfunction. DesignRandomized, double-masked, sham-controlled clinical trial. SettingSingle-center, tertiary referral center. Participants42 patients with refractory obstructive MGD associated with lid tenderness. InterventionsEnrolled patients received one of the following treatments: 1) MG probing plus post-procedural topical sulfacetamide/prednisolone ointment (Blephamide®), 2) MG probing plus post-procedural lubricating ointment (GenTeal), or 3) sham probing plus GenTeal ointment. The probing was performed on the upper lids of both eyes. Main outcome measuresPrimary outcome measures were symptoms as measured by Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE), as well as tear break-up time (TBUT). Secondary outcome measures were other clinical signs. Safety of the procedure was also evaluated by investigating the treatment-related adverse events. At baseline and 4 weeks after the procedure a masked observer evaluated the following outcome measures: symptom questionnaires, including OSDI and SANDE, upper lid tenderness, lid margin telangiectasia, corneal fluorescein staining, conjunctival lissamine green staining, TBUT, Schirmer's test, and meibomian glands yielding liquid secretion (MGYLS). ResultsCompared to baseline, the MG probing/Blephamide® group showed significant improvements in both OSDI and SANDE scores and the MG probing/GenTeal group demonstrated a significant improvement only in SANDE score. In contrast, the Sham/GenTeal group did not show any statistically significant changes in symptoms. There were no statistically significant changes in clinical signs in any group at the 4-week visit, except for improvement of lid tenderness in the sham probing group. ConclusionsMG probing/Blephamide® results in a significant improvement in symptoms in patients with refractory obstructive MGD without any significant effect on clinical signs. Larger studies are warranted to determine the efficacy of MG probing. Trial registrationClinicaltrials.gov(identifier NCT02256969, Filed on 08/13/2014)

Clinical results of Intraductal Meibomian gland probing combined with intense pulsed light in treating patients with refractory obstructive Meibomian gland dysfunction: a randomized controlled trial

BackgroundThis study aims to optimize the therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their positive effects and reduce their limitations.MethodsThis randomized, assessor blind study includes 45 patients (90 eyes) with refractory o-MGD who were divided into 3 groups via allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time), and combined MGP-IPL (group III, MGP first followed by an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and lid margin finding results were assessed at baseline, 3 weeks after final treatment for groups I and III, 3 and 12 weeks after MGP for group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected for all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction, and Kruskal-Wallis tests were used for data analysis.ResultsFor all 3 groups, all previously mentioned indexes improved significantly following treatment (P<0.01). MGP-IPL was better than IPL and MGP in terms of post-treatment SPEED, TBUT, meibum grade, and lid telangiectasia (P<0.05/3). Furthermore, the MGP-IPL was better than IPL in terms of lid tenderness and better than MGP in terms of orifice abnormality (P< 0.05/3). Six months later, the SPEED for the MGP-IPL was also significantly lower than other groups (P<0.05/3). Moreover, no patients in the MGP-IPL group expressed the need to be treated again compared to 35.7% or 20% of patients in the IPL or MGP groups, respectively.ConclusionsCompared with IPL or MGP alone, the combination MGP-IPL produced best results in relieving all signs and symptoms and helping patients attain long-lasting symptom relief.Trial registrationhttp://clinicaltrials.gov, ChiCTR1900021273 (retrospectively registered February 9, 2019).

&lt;p&gt;Intraductal meibomian gland probing: background, patient selection, procedure, and perspectives&lt;/p&gt;

Obstructive meibomian gland dysfunction is the most common cause of dry eye. Its conventional treatment has focused on using heat and pressure with anti-inflammatory and antimicrobial therapies but has often been a frequent, frustrating experience for patient and physician. New evidence from Meibomian gland intraductal probing suggests fixed intraductal strictures and obstruction correlating to periductal fibrosis first described in 1997. The use of intraductal probing has been reported, by this author and in at least ten independent peer-reviewed academic papers from around the world, to consistently lead to statistically significant improvement in signs and symptoms of gland dysfunction including cases refractory to other extensive treatments. This review will focus on the background of meibomian gland intraductal probing as well as patient selection, procedure, and perspectives.

Effectiveness of Intraductal Meibomian Gland Probing in Addition to the Conventional Treatment in Patients with Obstructive Meibomian Gland Dysfunction

ABSTRACTPurpose: To evaluate the effectiveness of intraductal meibomian gland probing in addition to conventional treatment for the management of obstructive meibomian gland dysfunction (O-MGD).Methods: Totally, 40 patients were divided into two groups to receive either conventional treatment alone (group 1: 40 eyes of 20 patients) or conventional treatment plus probing (group 2: 40 eyes of 20 patients). The ocular surface disease index score, Schirmer 1 test, tear film break-up time, Oxford grading of ocular surface, meibum expressibility, and quality scores were evaluated baseline and compared with the end of treatment (day 30 and day 90).Results: There was no significant difference in baseline scores between groups (All p > 0.05). All scores demonstrated significantly improvement from baseline in both group, and it was faster in group 2 (All p < 0.05).Conclusion: This study showed that intraductal meibomian gland probing seems to provide rapid symptom relief and clinical improvement for patients with O-MGD.

Efficacy of Intraductal Meibomian Gland Probing on Tear Function in Patients With Obstructive Meibomian Gland Dysfunction.

To assess the efficacy and safety of intraductal meibomian gland probing in patients with obstructive meibomian gland dysfunction who experienced little improvement with eyelid warming, massage, or artificial tears. Forty-nine patients with obstructive meibomian gland dysfunction were randomly divided into 2 groups: intraductal meibomian gland probing with 0.1% fluorometholone (group I), and 0.1% fluorometholone alone (group II). Subjective symptom scores and objective signs, including lid margin abnormalities, meibum quality and expressibility, meibomian gland dropout, fluorescein staining, tear break-up time (TBUT), and Schirmer I test results, were recorded before treatment and after 1 day, 1 week, and 1 month posttreatment. Clinical subjective symptoms and objective signs including meibum grade, TBUT, lid margin abnormalities, and fluorescein staining demonstrated significant improvements in both groups after treatment over time (all P < 0.05), and group I was better than group II 1 month after treatment in meibum grade (6.1 ± 3.3 vs. 10.4 ± 4.9, respectively; P < 0.001), lid margin abnormalities (0.8 ± 0.1 vs. 1.3 ± 0.3, respectively; P < 0.001), and TBUT (8.2 ± 2.1 vs. 7.0 ± 3.0, respectively; P = 0.0293). Before applying any medications, 76% of patients obtained immediate symptom relief 1 day after probing. However, the Schirmer I test results and meibomian gland dropout were insignificant pre- and posttreatment in either group (P > 0.1, respectively). Intraductal meibomian gland probing demonstrated significant efficacy in symptom relief and tear film stabilization. Probing helped release accumulated meibum and could help increase the accessibility of diseased meibomian glands to topical corticosteroids.

Effectiveness of Intraductal Meibomian Gland Probing for Obstructive Meibomian Gland Dysfunction.

To evaluate the short-term effectiveness of intraductal meibomian gland probing using modified Maskin cannulas in patients with obstructive meibomian gland dysfunction. The study prospectively included 58 eyes of 30 patients with a diagnosis of meibomian gland dysfunction who were refractory to medical treatment for at least 6 months. The patients were divided into 4 groups according to the number of probing procedures applied. During probing, sterile modified Maskin probes 2, 2.5, 4, and 6 mm in length were used. A tarsal massage was recommended after medical treatment. Preoperatively, then postoperatively at 1 week, 1 month, and 3 months, the Schirmer 1 test was performed, tear break-up time was measured, and images of the anterior segment were recorded. In addition, the Ocular Surface Disease Index questionnaire was completed at baseline and at 3 months. In all groups, there were no statistically significant differences between Schirmer 1 test results at preoperative and postoperative 3 months, but tear break-up time values measured at baseline and at 3 months differed significantly (5 seconds, 13 seconds, P < 0.001). In the analyses of anterior segment photographs of all patients, statistically significant postprocedural decreases in conjunctival hyperemia (P < 0.0001) and eyelid margin vascularization (P = 0.004) were detected, and the later Ocular Surface Disease Index scores showed a significant improvement between preop and 3 months. A procedure using modified Maskin probes was effective and reliable in the short term for patients with meibomian gland dysfunction.

Emerging treatment options for meibomian gland dysfunction

Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A.