Evaluation of the efficacy of optimal pulsed technology treatment in patients with cataract and Meibomian gland dysfunction in the perioperative period

Perioperative intense pulsed light to prevent and improve symptoms of post-laser corneal refractive surgery dry eye. A randomized clinical trial

PURPOSE

To evaluate the efficacy of perioperative IPL therapy in preventing postoperative ocular surface disorders in patients undergoing corneal laser refractive surgery.

DESIGN

randomized, controlled, clinical trial with triple-blinding.

METHODS

Setting: Vissum Miranza - Alicante; Study population: 61 patients randomized in two groups: 31 study patients (perioperative IPL + laser refractive surgery) and 30 control patients (perioperative placebo + laser refractive surgery). Follow-up was conducted over a 6-month period; Intervention: Each participants underwent three IPL sessions with a two-week interval between each session (pre-surgery, post-surgery week-one, and post-surgery week-three). For controls, placebo was administered following the same protocol.

MAIN OUTCOMES MEASURES

visual outcomes and refraction, slit-lamp examination, corneal topography, visual analogue scale questionnaire and Oculus Keratograph 5 M including tear meniscus height, non-invasive tear break- up time, ocular redness, infrared meibography and Ocular Surface Disease Index (OSDI) questionnaire.

RESULTS

61 randomized eyes were included. No significant differences were observed in terms of uncorrected and corrected distance visual acuity (UDVA, CDVA), refractive error or corneal aberrations. A statistically significant improvement in OSDI score (change -8.47, p = 0.043), tear meniscus (change 0.05 mm, p = 0.004) and Meibography (change -0.42, p = 0.012) was observed at the third postoperative month in the study group. Additionally, at the sixth postoperative month, there were statistically significant improvements in tear meniscus (change 0.06 mm, p = 0.018), tear break-up-time (change 1.68 s, p = 0.039) and Meibography (change -0.37, p = 0.030).

CONCLUSIONS

Results suggest that perioperative IPL therapy applied to laser corneal refractive surgery improves objective and subjective ocular surface parameters over non-IPL-treated control patients and early postoperative dry eye symptoms.

Analysis of Treatment Efficacy of Intense Pulsed Light (M22) for Meibomian Gland Dysfunction with Demodex Mites

Objective

To investigate the effectiveness of intense pulsed light (M22) in treating patients with meibomian gland dysfunction (MGD) caused by demodex mites.

Methods

A total of 100 patients (100 eyes) diagnosed with demodex mites through microscopic examination at Shanxi Bethune Eye Clinic between June 2021 and May 2023 were selected using convenience sampling. The patients were randomly divided into two groups: an experimental group (n=50) and a control group (n=50). The control group received comprehensive treatment consisting of artificial tears, warm compress, anti-inflammatory eye ointment, hypochlorous acid cleansing, okra cotton pad, and meibomian gland massage. In addition to the comprehensive treatment, the experimental group received intense pulsed light (M22) therapy. After 8 weeks of treatment, the mite clearance rate and cure rate of dry eye were measured for both groups. The recurrence rate of dry eye was also observed 4 weeks after discontinuing M22 treatment.

Results

The experimental group achieved a mite clearance rate of 88.0%, while the control group had a rate of 58.0%, with a statistically significant difference (χ2 = 5.43, P = 0.017). Regarding the cure rate of dry eye, the experimental group showed a rate of 92.0%, while the control group had a rate of 82.0%, with a statistically significant difference (χ2 = 3.61, P = 0.021). In terms of the recurrence rate of dry eye, the experimental group exhibited a rate of 13.04%, while the control group had a rate of 26.83%, with a statistically significant difference (χ2 = 4.18, P = 0.016).

Conclusion

Intense pulsed light (M22) demonstrated superior efficacy in eradicating demodex mites, treating dry eye, and maintaining the treatment's effectiveness compared to comprehensive treatment with medication in patients suffering from meibomian gland dysfunction with demodex mites.

Efficacy of vector thermal pulsation treatment in reducing postcataract surgery dry eye disease in patients affected by meibomian gland dysfunction

PURPOSE

To evaluate the effect of a single LipiFlow vector thermal pulsation treatment performed before cataract surgery in reducing signs and symptoms of postoperative dry eye disease (DED) in patients with mild-moderate meibomian gland dysfunction (MGD).

SETTING

Eye Clinic, Careggi Hospital, University of Florence, Florence, Italy.

DESIGN

Prospective unmasked randomized controlled clinical trial.

METHODS

This study included patients affected by age-related cataract and mild-moderate MGD, who were randomized into 2 groups: (1) a single LipiFlow treatment performed at 5 preoperative weeks and (2) warm compresses and eyelid massages twice a day for 1 preoperative month (control group). Noninvasive break-up time (NI-BUT), Schirmer test, Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and MG functionality parameters were evaluated at visit 0 (5 preoperative weeks), visit 1 (1 preoperative week), and visit 2 (1 postoperative month). Confocal microscopy of the MG of lower eyelids was performed at visit 0 and visit 2.

RESULTS

A total of 46 patients (46 eyes) were enrolled. In the LipiFlow group (n = 23), NI-BUT, SPEED questionnaire, and MG functionality parameters significantly improved at visit 1 ( P < .05) and visit 2 ( P < .05) compared with baseline and remained stable postoperatively. In the control group (n = 23), they did not significantly improve after treatment, while worsened postoperatively. Moreover, the changes in all parameters from baseline were significantly different between the 2 groups. Confocal microscopy imaging highlighted lower postoperative MG alterations in the LipiFlow group.

CONCLUSIONS

A single preoperative LipiFlow treatment was effective in preventing postcataract surgery DED in patients with mild-moderate MGD. Postoperatively, treated patients displayed a better ocular surface status compared with warm compresses.

Relationship between dry eye and expressions of CXCR3 and CCR5 after ocular acid burn

OBJECTIVE

To investigate the manifestation of dry eye and its relationship with CXCR3 and CCR5 expression in patients with ocular acid burns.

METHODS

This is a case-control study. A total of 27 eyes of 22 cases ocular with acid burns of I-V degrees from Jan.2020 to Feb.2021 in Jinshan Hospital of Fudan University were selected as observation group, and 8 eyes of 8 cases of normal people were selected as control group. The follow-up period was 3 months. The visual acuity, intraocular pressure (IOP), corneal fluorescein staining scores (CFS), breakup time of tear film (BUT), Schirmer I test, corneal thickness and tear meniscus height (TMH) were observed at 1 day, 1 and 3 months after injury. The protein expressions of CXCR3 and CCR5 were examined by ELISA and compared among groups at each time point.

RESULTS

BUT and Schirmer I tests value in the observation group were lower than those in the control group 3 months after injury (BUT: Group I ~ IV p = 0.0266, p = 0.0222, p = 0.0003, p = 0.0059, respectively; Schirmer I test: Group I ~ IV p = 0.0027, p = 0.0033, p = 0.0016, p = 0.0032, respectively). CFS scores were higher than those in the control group at 1 day after injury (all p < 0.0001), but decreased gradually at 1 and 3 months after injury (Group I ~ IV p = 0.0042, p = 0.0096, p < 0.0001, p < 0.0001, respectively). The corneal thickness and TMH 1 day after injury were higher than those in the control group (corneal thickness: Group II ~ IV p = 0.0010, p < 0.0001, p < 0.0001, respectively; TMH: Group II ~ IV p = 0.0002, p < 0.0001, p < 0.0001, respectively), and also higher than those at 1 month and 3 months after injury (corneal thickness: Group II ~ IV p = 0.0010, p < 0.0001, p < 0.0001, respectively; TMH: Group II ~ IV p = 0.0345 and p = 0.0045, p = 0.0005 and p < 0.0001, p = 0.0114 and p = 0.0019, respectively). The expression levels of CXCR3 and CCR5 protein were significantly negatively correlated with BUT (all p < 0.0001), and CXCR3 and CCR5 were also significantly negatively correlated with Schirmer I test value (p < 0.0001, p = 0.0004, respectively).

CONCLUSION

Ocular acid burns can cause dry eye, and the expression of CXCR3 and CCR5 protein in tears may be related to the occurrence of dry eye after ocular acid burn.

Factors influencing the clinical outcomes of intense pulsed light for meibomian gland dysfunction

To observe the clinical outcomes of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) and identify its influencing factors.Forty-eight eyes of 48 patients with MGD were included. Subjects were followed up 5 times on day 1, day 15, day 30, day 45, and day 120, and underwent 3 sessions of the IPL treatment on day 1, day 15 and day 30. Gender, age, duration of MGD, time of video display terminal usage, and severity of MGD were recorded at baseline. At every visit, Ocular Surface Disease Index (OSDI), eyelid margin abnormality score, tear film breakup time, Schirmer I test (S ɪ t) and corneal fluorescein staining were recorded. The clinical parameters before and after 3 IPL treatments were compared. Univariate and multivariable logistic regression analyses were performed to explore influencing factors.Compared with baseline, the tear film breakup time was increased and the corneal fluorescein staining score and OSDI were significantly decreased on day 45 and day 120 (all P < .001). In univariate analysis, among the patients with a younger age (18-39 years), moderate MGD, higher baseline S ɪ t and higher baseline OSDI, the IPL treatment had a higher effective rate (P = .032, .004, .024, and .014 respectively). The MGD severity was strongly associated with effective IPL, and patients with moderate MGD had an OR of 22.454 compared with the severe MGD patients (OR = 22.454, 95% CI: 2.890-174.436, P = .003).IPL effectively improves clinical symptoms and some signs in MGD patients. Age, MGD severity, baseline S ɪ t and baseline OSDI are potential factors that may influence the clinical outcomes of IPL. MGD severity is an independent influencing factor.

Effects of Lipiflow Treatment Prior to Cataract Surgery: A Prospective, Randomized, Controlled Study

To investigate the effects of preoperative Lipiflow (Johnson & Johnson, Jacksonville, FL, USA) treatment before cataract surgery on meibomian gland dysfunction (MGD) and dry eye induced by surgery.

DESIGN

Prospective, randomized controlled study.

METHODS

This study comprised 124 eyes of 124 patients with planned surgery for senile cataract. Participants were randomly allocated into control and Lipiflow groups based on administration of Lipiflow treatment 3 weeks before cataract surgery. For meibomian gland (MG) evaluation, MG atrophy, degree of gland expressibility, and quality of gland secretions were examined at the baseline visit and 1 and 3 months postoperatively. Ocular surface parameters of tear film break-up time, Oxford corneal staining score, and tear film lipid layer thickness were measured at each visit. Ocular Surface Disease Index and Dry Eye Questionnaire were also assessed.

RESULTS

The control group exhibited a significant decrease in MG expressibility, worsened meibum quality, decreased lipid layer thickness, and worsened corneal staining after cataract surgery. Also, dry eye symptom showed significant worsening. Conversely, the Lipiflow group showed significantly improved MG patency and meibum quality, increased tear film break-up time, and reduced corneal staining, and presented improved subjective outcomes reported on both Ocular Surface Disease Index and Dry Eye Questionnaire. The improvement of each parameter in the Lipiflow group showed a linear correlation with baseline MGD grade. In addition, patients without baseline MGD showed less worsening or improvement of MGD and dry eye induced by surgery, with preoperative Lipiflow treatment.

CONCLUSIONS

Preoperative Lipiflow treatment conducted before cataract surgery may be a safe and effective intervention for relieving MGD and dry eye induced by surgery. It might be recommended not only for the patients with preoperative MGD but also for those without baseline MGD, to prevent the development of MGD and dry eye induced by ocular surgeries.

Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction

CLINICAL RELEVANCE

Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients 'visual health and quality of life.

BACKGROUND

In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD.

METHODS

In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups.

RESULTS

Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = -0.32; p < 0.001, r = -0.52).

CONCLUSION

IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.

Iatrogenic Dry Eye Disease: Dealing with the Conundrum of Post-Cataract Discomfort. A P.I.C.A.S.S.O. Board Narrative Review

The incidence and prevalence of dry eye disease (DED) after cataract surgery is greatly underestimated. The severity of dry eye symptoms has been reported to peak 7 days after cataract surgery and may persist for months, significantly affecting patients' quality of life (QoL). The importance of considering surgical outcomes not only in terms of visual acuity, but also in terms of the patients' QoL, necessitates the assessment and evaluation of the ocular surface by the cataract surgeon prior to the procedure. This narrative review, drafted by the P.I.C.A.S.S.O. (Italian Partners for the Correction of Ocular Surface Alterations) board, analyses the physiopathology of post-cataract surgery DED and highlights the pre-, intra- and postoperative risk factors that may alter ocular surface homeostasis; it proposes a practical comprehensive algorithm for the prevention, treatment and management of DED associated with cataract surgery. Particular attention needs to be paid to the pre- and intraoperative risk factors to reduce the incidence of postoperative dry eye and to improve cataract surgery outcome.