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Gupta AS, Massaro M, Bunya VY. Intense pulsed light treatment for the management of meibomian gland dysfunction. Curr Opin Ophthalmol 2024; 35:322-328. [PMID: 38813738 DOI: 10.1097/icu.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD. RECENT FINDINGS In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks. SUMMARY There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.
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Affiliation(s)
- Angela Satya Gupta
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Min JS, Jun I, Kim TI, Arita R, Seo KY. Comparison of Intense Pulsed Light Treatments including Upper Lid or Lateral Canthus in Patients of Meibomian Gland Dysfunction. J Clin Med 2024; 13:3581. [PMID: 38930110 DOI: 10.3390/jcm13123581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: To determine the differences in the effects of intense pulsed light (IPL) treatment when including the upper and lower lid or lateral canthus area in patients with meibomian gland dysfunction (MGD). Methods: Patients who underwent three IPL treatment sessions at 3-week intervals were divided into three groups according to the treatment sites: group A, lower lid; group B, upper and lower lids; and group C, lower lid and lateral canthal area. Before and after the IPL treatment sessions, we obtained the lid abnormality score (LAS), meibum expressibility (ME), meibum quality (MQ), lipid layer thickness (LLT), type I Schirmer test (ST), tear break-up time (TBUT) test, corneal fluorescein staining scores (CFSs), and Ocular Surface Disease Index (OSDI). Results: IPL treatment significantly improved LASs, ME, MQ, TBUT, CFS, and OSDI values in all groups. Differences in LAS values before and after IPL treatment were significantly greater in groups B and C than those in group A. Conclusions: IPL treatment encompassing the upper lid and lateral canthus together with the lower lid elicited additional improvement in patients with MGD. The additional effect on treating the lateral canthus was similar to the effect observed on the additional treatment of the upper lid.
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Affiliation(s)
- Ji Sang Min
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Cornea Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Cornea Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Tae-Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Cornea Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Reiko Arita
- Itoh Clinic, Saitama 337-0042, Japan
- Lid and Meibomian Gland Working Group, Saitama 337-0042, Japan
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Cornea Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Pac CP, Sánchez-González JM, Rocha-de-Lossada C, Mercea N, Ferrari F, Preda MA, Rosca C, Munteanu M. Intense Pulsed Light Therapy for Dry Eye Disease: Analyzing Temporal Changes in Tear Film Stability and Ocular Surface between IPL Sessions. Healthcare (Basel) 2024; 12:1119. [PMID: 38891194 PMCID: PMC11171838 DOI: 10.3390/healthcare12111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dry eye disease (DED), a prevalent condition with a multifactorial etiology, significantly impacts global health by causing discomfort and visual disturbance. This historical cohort study evaluates the efficacy of Intense Pulsed Light (IPL) therapy on meibomian gland dysfunction (MGD)-related evaporative DED. METHODS The study involved 110 patients (220 eyes) who underwent IPL therapy. Ethical approval was secured, and informed consent was obtained from all participants. A Tearcheck® (ESWvision, Houdan, France) device was used for ocular surface evaluation, measuring tear film stability (NIFBUT, NIABUT), tear film quantity (CTMH, TTMH), and inflammation (OSIE). The study assessed tear film and ocular surface health across multiple IPL sessions. RESULTS Significant improvements were observed in subjective symptoms (EFT score increased from 29.10 ± 8.87 to 35.91 ± 7.03, p < 0.01), tear film stability (NIFBUT increased from 9.37 ± 6.04 to 10.78 ± 5.83 s, p < 0.01; NIABUT increased from 11.07 ± 4.98 to 12.34 ± 4.66 s, p < 0.01), and tear film surface evaluation (TFSE score decreased from 337.78 ± 414.08 to 206.02 ± 240.44, p < 0.01). Tear film quantity remained unchanged (CTMH and TTMH, p > 0.05). CONCLUSIONS IPL therapy is a promising treatment for DED, improving symptoms and ocular surface health. Further research is warranted to explore long-term efficacy and optimization.
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Affiliation(s)
- Cristina-Patricia Pac
- Department of Ophthalmology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (C.-P.P.); (M.A.P.); (M.M.)
| | | | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Qvision VITHAS Almeria Hospital, 04120 Almeria, Spain;
- Department of Ophthalmology, VITHAS Malaga, 29016 Malaga, Spain
- Department of Ophthalmology, Regional University Hospital of Malaga, 29009 Malaga, Spain
- Department of Surgery, University of Seville, Ophthalmology Area, 41009 Seville, Spain
| | - Nadina Mercea
- Department of Ophthalmology, Municipal Emergency Clinical Hospital, 300254 Timisoara, Romania;
| | - Francis Ferrari
- Clinique Espace Nouvelle Vision, 6 Rue de la Grande Chaumière, 75006 Paris, France;
| | - Maria Alexandra Preda
- Department of Ophthalmology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (C.-P.P.); (M.A.P.); (M.M.)
| | - Cosmin Rosca
- Oculens Clinic, Calea Turzii no. 134-136, 400347 Cluj Napoca, Romania;
| | - Mihnea Munteanu
- Department of Ophthalmology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (C.-P.P.); (M.A.P.); (M.M.)
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Auger R, Trone MC, Chhuy E, Poinard S, Thuret G, Gain P. Efficacy and safety of intense pulsed light delivered by the C.STIM® for treatment of Meibomian gland dysfunction. J Fr Ophtalmol 2024; 47:104016. [PMID: 37945431 DOI: 10.1016/j.jfo.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Intense pulsed light (IPL) appears to be a promising treatment for Meibomian gland dysfunction (MGD), the most common cause of dry eye disease. C.STIM® is a new IPL device. We report the first safety and efficacy study in clinical practice. MATERIALS AND METHODS Patients with moderate MGD treated with C.STIM® were included. Three IPL sessions were performed at D0, D15 and D45 with 4 shots per side (fluence of 8J/cm2). Clinical evaluation was performed at D0, D45 and M3 with several parameters: BUT, OSDI and Oxford scales, meibomian gland evaluation (morphology, quality and expressibility of meibum). The Lacrydiag® imaging device was used for objective evaluation of interferometry, meibography, tear meniscus height and NIBUT. The primary endpoint was the change in NIBUT between D0 and M3. Data collection was retrospective. Longitudinal analysis and a non-parametric linear mixed-effects model (R software) were used for statistical analysis. RESULTS Thirty-five patients were included. NIBUT increased significantly between D0 and M3, with a mean difference of 2.6seconds (95% CI 2.0; 3.1, P<0.001). The other parameters studied also changed significantly, except for meibography (percentage of loss and morphology) and tear meniscus height. No adverse event was noted. CONCLUSION C.STIM® appears safe and effective in the treatment of MGD, although a randomized controlled trial is needed to validate these results.
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Affiliation(s)
- R Auger
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France
| | - M-C Trone
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France.
| | - E Chhuy
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France
| | - S Poinard
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France
| | - G Thuret
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France
| | - P Gain
- Ophtalmologie CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France
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Ballesteros-Sánchez A, Sánchez-González JM, Gutiérrez-Ortega R, Gargallo-Martínez B. Diamond Bur Microblepharoexfoliation Combined with Intense Pulse Light and Meibomian Gland Expression for Evaporative Dry Eye: A Short-term Controlled Clinical Trial. Ophthalmol Ther 2024; 13:1223-1237. [PMID: 38467993 DOI: 10.1007/s40123-024-00919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION To assess the efficacy and safety of the combination of microblepharoexfoliation (MBE), intense pulse light (IPL) and meibomian gland expression (MGX) for treatment of meibomian gland dysfunction (MGD). METHODS This was a prospective, parallel-control trial conducted from April 2022 to January 2023. Participants were assigned to receive either three sessions of MBE-IPL-MGX treatment and home-based therapy (treatment group) or home-based therapy alone (control group). Outcome measures were assessed at baseline and after 2-month follow-up. RESULTS Seventy eyes of 70 patients were enrolled. MBE-IPL-MGX treatment achieved better improvements than home-based therapy in ocular surface disease index (OSDI) and symptom assessment in dry eye (SANDE) scores, noninvasive tear film break-up time (NIBUT), lipid layer grade (LLG), loss area meibomian gland (LAMG) and meibomian gland yielding secretion score (MGYSS). The mean differences between the two groups were as follows: OSDI (- 11.23 ± 4.68 points, P < 0.001), SANDE (- 24.63 ± 13.41 points, P < 0.001), NIBUT (1.3 ± 1.57 s, P = 0.033), LLG (0.4 ± 0.04 points, P = 0.003), LAMG (- 2.85 ± 1.69%, P = 0.023) and MGYSS (7.5 ± 2.32 points, P < 0.001). In addition, the increment (Δ) of MGYSS after MBE-IPL-MGX treatment was significantly higher in MGD grades 2 and 3 (all P < 0.001). CONCLUSIONS MBE-IPL-MGX treatment is an effective and well-tolerated procedure that improves dry eye symptoms and signs as well as meibomian gland secretions in patients with MGD. In addition, this treatment is recommended for MGD grades 2 and 3.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain.
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - Ramón Gutiérrez-Ortega
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain
- Department of Ophthalmology, Optometry, Otorhinolaryngology and Anatomic Pathology, University of Murcia, Murcia, Spain
| | - Beatriz Gargallo-Martínez
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain
- Department of Ophthalmology, Optometry, Otorhinolaryngology and Anatomic Pathology, University of Murcia, Murcia, Spain
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Maskin SL, Toland C. Meibomian Gland Probing Stimulates a Proliferative Epithelial Response Resulting in Duct Regeneration. Clin Ophthalmol 2024; 18:631-645. [PMID: 38445253 PMCID: PMC10913816 DOI: 10.2147/opth.s452549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose To demonstrate that the meibomian gland ductal basement membrane and basal epithelial cell layer are in continuity with and may derive from lid margin orifice-associated rete ridge epithelial/basement membrane structures (OARREBS) and to characterize changes in the distal duct microanatomy after meibomian gland probing (MGP) using in vivo confocal microscopy (IVCM). Patients and Methods Pre/post-MGP IVCM examinations were performed on upper lids. Thirty-six identical glands from 20 lids of 16 patients (49.24 ±17.11 y/o with 13:3 F:M) were identified, analyzed, and compared to control cases. Statistical analyses were performed using ImageJ software and IBM SPSS version 27. All MGPs were performed within 12 weeks of the initial examination. Post-MGP follow-up exams occurred at 5.03 ±4.48 months. Results Post-MGP images showed more superficially organized OARREBS with accelerated and more superficial basement membrane formation, and an average increase of 32.2%, 25.4%, 32.04%, 77.7%, and 81.3% in duct wall epithelial cell layers (DWECL) (p < 0.001, compared to control (CTC) p < 0.001), distal duct wall thickness (DWT) (p < 0.001, CTC p < 0.001), proximal DWT (p < 0.001, CTC p < 0.001), distal lumen area (p < 0.001, CTC p = 0.037), and proximal lumen area (p < 0.001, CTC p = 0.007), respectively. The increase in the distal DWT and lumen area correlated with the months of follow-up (p = 0.004 and p = 0.010, respectively). Immediate post-MGP imaging revealed the probe track confined to the ductal epithelial compartment. Conclusion MGP appears to stimulate a proliferative epithelial response characterized by an accelerated more superficial formation of ductal basement membrane with increased DWECL as well as DWT and lumen area at two separate duct foci. These findings suggest activation of lid margin meibomian gland precursor cells and confirm that MGP stimulates an epithelial regenerative phenomenon, not a fibrotic one.
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Di Zazzo A, Barabino S, Fasciani R, Aragona P, Giannaccare G, Villani E, Rolando M. One Soul and Several Faces of Evaporative Dry Eye Disease. J Clin Med 2024; 13:1220. [PMID: 38592038 PMCID: PMC10932174 DOI: 10.3390/jcm13051220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 04/10/2024] Open
Abstract
The ocular surface system interacts with, reacts with, and adapts to the daily continuous insults, trauma, and stimuli caused by direct exposure to the atmosphere and environment. Several tissue and para-inflammatory mechanisms interact to guarantee such an ultimate function, hence maintaining its healthy homeostatic equilibrium. Evaporation seriously affects the homeostasis of the system, thereby becoming a critical trigger in the pathogenesis of the vicious cycle of dry eye disease (DED). Tear film lipid composition, distribution, spreading, and efficiency are crucial factors in controlling water evaporation, and are involved in the onset of the hyperosmolar and inflammatory cascades of DED. The structure of tear film lipids, and subsequently the tear film, have a considerable impact on tears' properties and main functions, leading to a peculiar clinical picture and specific management.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Foundation Campus Bio-Medico University Hospital, 00128 Rome, Italy
- Ophthalmology Unit, Campus Bio-Medico University, 00128 Rome, Italy
| | - Stefano Barabino
- Ocular Surface & Dry Eye Center, ASST Fatebenefratelli SACCO, Kilan Univeristy, 20123 Milan, Italy;
| | - Romina Fasciani
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, 00128 Rome, Italy;
- Ophtalmology Unit, Catholic University of “Sacro Cuore”, 00128 Rome, Italy
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98122 Messina, Italy;
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Edoardo Villani
- Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, University of Milan, 20123 Milan, Italy;
| | - Maurizio Rolando
- Ocular Surface and Dry Eye Center, ISPRE Ophthalmics, 16129 Genoa, Italy;
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Pratomo TG, Zaifar A, Wibowo NP, Suryono AN, Aziza Y. Current application of intense pulsed light for the management of dry eye disease: A systematic review and meta-analysis. Indian J Ophthalmol 2024; 72:S183-S190. [PMID: 38146980 DOI: 10.4103/ijo.ijo_671_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/03/2023] [Indexed: 12/27/2023] Open
Abstract
This review explored intense pulsed light (IPL) as an alternative treatment for dry eye disease (DED) symptom relief by correcting tear-film homeostasis. A systematic search was performed in March 2022 on five databases (Medline, Embase, SCOPUS, ProQuest, and EBSCO). Studies were extracted for the following outcomes of interest: standard patient evaluation of eye dryness questionnaire (SPEED), ocular surface disease index (OSDI), tear break-up time (TBUT), and corneal fluorescein staining (CFS). All studies published up to March 2022 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Thirteen studies were included in this study. A total of 931 individuals and 1454 numbers of eyes were reviewed in this meta-analysis. Among studies that explored and reported the effect of IPL in individuals with DED, TBUT and OSDI improved significantly post intervention, with a standardized mean difference (SMD) of 1.02 [95% CI 0.41-1.64] and 0.28 [95% CI 0.04-0.52], respectively. CFS and SPEED scores, however, showed no statistically significant difference, with an SMD of 0.22 [95% CI -0.19 to 0.64] and 0.28 [95% CI -0.11 to 0.66], respectively. In conclusion, current evidence indicates IPL as a possible adjunctive treatment in individuals with DED in an otherwise limited treatment option. Further studies through more extensive trials are needed to validate this finding and elucidate its mechanism.
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Affiliation(s)
- Tiara G Pratomo
- Department of Ophthalmology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
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Martínez-Hergueta MC, Cantó-Cerdán M, Amesty MA, García-Corral MJ, Casanova-Blanquer L, Plaza-Puche AB, Alió JL, Alió Del Barrio JL. Perioperative intense pulsed light to prevent and improve symptoms of post-laser corneal refractive surgery dry eye. A randomized clinical trial. Asia Pac J Ophthalmol (Phila) 2024; 13:100029. [PMID: 38383079 DOI: 10.1016/j.apjo.2023.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/23/2024] Open
Abstract
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.
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Affiliation(s)
- María C Martínez-Hergueta
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Ophthalmology Department, Hospital General de Elda, Alicante, Spain
| | - Mario Cantó-Cerdán
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Maria A Amesty
- Oculoplastic Unit, Vissum (Miranza Group), Alicante, Spain
| | - M Jose García-Corral
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | | | - Ana B Plaza-Puche
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió Del Barrio
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain.
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Jang JH, Lee K, Nam SH, Kim J, Kim JY, Tchah H, Lee H. Comparison of clinical outcomes between intense pulsed light therapy using two different filters in meibomian gland dysfunction: prospective randomized study. Sci Rep 2023; 13:6700. [PMID: 37095152 PMCID: PMC10126147 DOI: 10.1038/s41598-023-33526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
Our study compared treatment efficacy between cut-off and notch filters in intense pulsed light (IPL) therapy for meibomian gland dysfunction (MGD) through a prospective, randomized paired-eye trial. Additionally, the efficacy of IPL treatment alone was investigated by restricting other conventional treatments. One eye was randomly selected for an acne filter and the other for a 590-nm filter. Identical four regimens of IPL treatments were administered. The tear break-up time (TBUT), Oxford scale, Sjögren's International Clinical Collaborative Alliance (SICCA) staining score, tear matrix metalloproteinase-9 (MMP-9) expression, tear osmolarity, and Ocular Surface Disease Index (OSDI) questionnaires were evaluated before and after IPL. Meibomian gland (MG) parameters were measured. When combining the results from both filters, the TBUT, SICCA staining score, OSDI score, and upper and lower lid meibum expressibility were improved after IPL. No significant differences were found between the two filters in the TBUT, Oxford scale, SICCA staining score, MMP-9 expression, tear osmolarity, and MG parameters. Although not significant, the acne filter showed better treatment efficacy than that in the 590-nm filter. IPL alone is efficacious in terms of ocular surface parameters, MG function, and subjective symptoms. Regarding filter selection, both acne and 590-nm filters are promising options for MGD treatment.
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Affiliation(s)
- Joon Hyuck Jang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Koeun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Sang Hyu Nam
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jin Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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11
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Zeng H, Gong L. A Review of Applications and Intracellular Mechanisms of Intense Pulsed Light in Eyelid Inflammatory Diseases. Photobiomodul Photomed Laser Surg 2023; 41:104-119. [PMID: 36927050 DOI: 10.1089/photob.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Objective: To evaluate relevant clinical outcomes and conclude possible mechanisms of intense pulsed light (IPL) in eyelid inflammation. Background: IPL devices were primarily applied in cutaneous vascular malformations and have been used in ocular diseases for about 20 years, mostly including meibomian gland dysfunction (MGD), blepharitis, and ocular rosacea. Recent findings: Seventy-two original clinical researches were included, 57 for MGD, 4 for blepharitis or blepharitis-related keratoconjunctivitis, and 11 for rosacea. Dry eye symptoms, (tear) break-up time (BUT), and meibomian structure and/or functions were improved in most patients, but production of reactive oxygen species is an important link in the photobiomodulation mediated by IPL, which can influence numerous signal pathways to achieve anti-inflammatory, anti-infective, and prodifferentiation effects. Conclusions: The evidence suggests that IPL is an effective therapeutic tool for most patients with MGD, but more clinical evidence is needed for other indications.
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Affiliation(s)
- Hongya Zeng
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Lan Gong
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital of Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China
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Suwal A, Hao J, Liu X, Zhou D, Jia Z, Liu H, Ren Y, Shao F, Lu C. Effect of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease. Klin Monbl Augenheilkd 2023; 240:163-168. [PMID: 36100251 DOI: 10.1055/a-1942-2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND This retrospective study aimed to evaluate the effect of intense pulsed light treatment (IPL) combined with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) related dry eye disease (DED) for the first time in Northeast China. METHODS Thirty-one MGD-related dry eye patients were managed by IPL-MGX from October to December 2019 in The First Hospital of Jilin University. Those patients had single IPL-MGX treatment with one follow-up visit, and no topical eye drops used were included in the study. General checkup and data collection helped in determining the age, sex, diagnosis, status of the MG, first noninvasive tear break-up time (1st NIBUT), average NIBUT, the height of tear film, and additional medical history. RESULTS There was an improvement in the function of the meibomian gland (MG), with a significant decrease in the MG dropouts in the upper eyelid (Rt eye, p = 0.0047; Lt eye, p = 0.0158) and lower eyelid (Rt eye, p = 0.0017; Lt eye, p = 0.0027) plus the average NIBUT (Rt eye, p = 0.0264) also showed improvement after the IPL-MGX treatment. Though no significant difference was reached with the average NIBUT of the Lt eye (p = 0.5256) and the NIBUT grade (Rt eye, p = 0.0578; Lt eye, p = 0.0588), there was an increased duration of the average NIBUT and improved NIBUT grading. The negative results may be because of the maximum severity of DED and the limited treatment times. CONCLUSIONS The result suggests that IPL-MGX was effective in treating MGD-related DED.
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Affiliation(s)
- Abhishek Suwal
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Jilong Hao
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Xiufen Liu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Dandan Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Zhifang Jia
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Liu
- Ophthalmology, Jiamusi University First Affiliated Hospital, Jiamusi, China
| | - Yu Ren
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Fei Shao
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
| | - Chengwei Lu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, China
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Giannaccare G, Vaccaro S, Pellegrini M, Borselli M, Carnovale Scalzo G, Taloni A, Pietropaolo R, Odadi AS, Carnevali A. Serial Sessions of a Novel Low-Level Light Therapy Device for Home Treatment of Dry Eye Disease. Ophthalmol Ther 2023; 12:459-468. [PMID: 36484948 PMCID: PMC9834479 DOI: 10.1007/s40123-022-00619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the changes that a recently developed at-home device using low-level light therapy (LLLT) produced in signs and symptoms of patients with dry eye disease (DED) owing to meibomian gland dysfunction (MGD). METHODS In this prospective study, patients with DED owing to MGD not successfully responding to first-line therapy (tear substitutes and eye lid hygiene) were treated with four serial sessions (every other day) of mask based on LLLT technology and dedicated for home use (my-mask®, Espansione Marketing S.p.A., Bologna, Italy). Non-invasive ocular surface examination was carried out by means of Keratograph 5M (Oculus, Wetzlar, Germany) before and after four mask sessions for the evaluation of (i) tear meniscus height (TMH); (ii) first and average non-invasive Keratograph breakup time (NIKBUT); (iii) meibomian gland loss (MGL). Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular discomfort symptoms. RESULTS Overall, 17 patients (3 male, 14 female; mean age 61.47 ± 11.93 years) were enrolled and all of them regularly completed the entire cycle of four sessions without reporting any adverse event. The mean values of NIKBUT first and NIKBUT average increased significantly after treatment (from 5.29 ± 2.60 at T0 to 9.04 ± 3.49 s at T1 [P = 0.001] and from 9.40 ± 3.81 to 11.28 ± 2.81 s [P = 0.017]); in parallel, the mean value of TMH increased significantly from 0.27 ± 0.06 to 0.32 ± 0.09 mm (P = 0.029). Conversely, there were not statistically significant differences for MGL (P = 0.346). In addition, the mean value of OSDI score decreased after treatment (from 32.00 ± 7.96 at T0 to 20.71 ± 8.03 at T1; P < 0.001). CONCLUSIONS One week of serial sessions of a newly developed LLLT device for home use significantly improved tear film production and stability along with ocular discomfort symptoms in patients with DED owing to MGD. These findings open up a new scenario for patients with MGD who can enjoy the unique benefits of LLLT at home.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy ,Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy ,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Rocco Pietropaolo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | | | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
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Giannaccare G, Pellegrini M, Carnovale Scalzo G, Borselli M, Ceravolo D, Scorcia V. Low-Level Light Therapy Versus Intense Pulsed Light for the Treatment of Meibomian Gland Dysfunction: Preliminary Results From a Prospective Randomized Comparative Study. Cornea 2023; 42:141-144. [PMID: 36582033 DOI: 10.1097/ico.0000000000002997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the safety and efficacy of low-level light therapy (LLLT) and intense pulsed light (IPL) for the treatment of meibomian gland dysfunction (MGD). METHODS Forty eyes of 40 patients with MGD were randomized to receive either LLLT or IPL. Four weekly sessions of LLLT (MY MASK-E, Espansione Marketing S.p.A., Bologna, Italy) and IPL (Eye-light device, Espansione Marketing S.p.A., Bologna, Italy) were performed. The following parameters were evaluated before and 2 weeks after the last session for each treatment: Standard Patient Evaluation of Eye Dryness questionnaire, noninvasive break-up time, tear meniscus height, redness score, meiboscore, and meibomian gland loss. RESULTS All patients completed regularly all the scheduled sessions, and no adverse events were reported in any of the groups. The Standard Patient Evaluation of Eye Dryness score significantly decreased after both LLLT and IPL (P < 0.001) although the improvement was significantly greater in the LLLT compared with the IPL group (-9.9 ± 3.2 vs. -6.75 ± 4.5; P = 0.014). Patients in the LLLT group showed a significantly higher increase in tear meniscus height compared with those in the IPL group (0.06 ± 0.10 mm vs. -0.01 ± 0.014; P = 0.040). In both groups, the noninvasive break-up time, redness score, meiboscore, and meibomian gland loss did not vary significantly after treatment (all P > 0.05). CONCLUSIONS Both LLLT and IPL were safe and effective in improving ocular discomfort symptoms in patients with MGD; however, the former determined a greater improvement in symptoms and an improvement of tear volume.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Ophthalmology, Ospedali Privati Forlì"Villa Igea", Forlì, Italy ; and
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | | | | | - Domenico Ceravolo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
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Vigo L, Pellegrini M, D’Angelo S, Carones F, Scorcia V, Giannaccare G. Effects of Serial Sessions of Activa Mask for the Treatment of Meibomian Gland Dysfunction. Ophthalmol Ther 2023; 12:209-216. [PMID: 36327001 PMCID: PMC9834468 DOI: 10.1007/s40123-022-00604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To analyze outcomes on objective ocular surface parameters and subjective symptoms of serial weekly sessions using the Activa mask in patients with meibomian gland dysfunction (MGD). METHODS This is a prospective study including patients with symptomatic MGD who were treated with four weekly sessions using the Activa mask (SBM Sistemi, Turin, Italy). Noninvasive ocular surface examination was carried out before (T0) and 2 weeks after the last mask session (T1) using Idra (SBM Sistemi, Turin, Italy) for the measurement of: (1) noninvasive break-up time (NIBUT); (2) lipid layer thickness (LLT); (3) tear meniscus height (TMH); (4) meibomian gland loss (MGL) of upper and lower eyelids. The I-Pen tear osmolarity system (I-Med Pharma Inc, Dollard-des Ormeaux, Quebec, Canada) was used to measure tear osmolarity values. Ocular discomfort symptoms were ascertained by means of the ocular surface disease index (OSDI) questionnaire. RESULTS All 25 patients (11 males, 14 females; mean age 57.1 ± 11.9 years) regularly completed the cycle of four mask sessions. No patients used prohibited medications, and no device-related adverse events were noted. At T1, mean values of NIBUT and LLT increased significantly compared to T0 (respectively from 6.0 ± 1.4 to 6.6 ± 1.2 s, P = 0.043, and from 53.2 ± 17.4 to 65.3 ± 16.3 nm, P < 0.001), while mean values of MGL and tear osmolarity decreased significantly (respectively from 17.1 ± 9.3 to 15.1 ± 8.0%, P = 0.014, and from 307.3 ± 12.2 to 301.5 ± 6.8 mOsm/l, P = 0.005). In parallel, OSDI score reduced significantly from 62.4 ± 11.7 at T0 to 34.5 ± 11.2 at T1 (P < 0.001). CONCLUSION Weekly serial sessions using the Activa mask significantly improved objective parameters of the ocular surface as well as subjective ocular discomfort symptoms in patients with recalcitrant MGD. As a further benefit from the treatment, patients were able to avoid the use of concomitant medications, apart from tear substitutes, throughout the study.
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Affiliation(s)
- Luca Vigo
- Carones Ophthalmology Center, Milan, Italy
| | - Marco Pellegrini
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy ,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy ,Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Sergio D’Angelo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
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Nguyen A, Kolluru A, Beglarian T. Dry eye disease: A review of anti-inflammatory therapies. Taiwan J Ophthalmol 2023; 13:3-12. [DOI: 10.4103/2211-5056.369606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 02/15/2023] Open
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Intense pulsed light treatment of the upper and lower eyelids in patients with moderate-to-severe meibomian gland dysfunction. Int Ophthalmol 2023; 43:73-82. [PMID: 35794405 DOI: 10.1007/s10792-022-02389-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We investigated the subjective and objective outcome after intense pulsed light (IPL) treatment and meibomian gland expression on the upper and lower eyelids compared with those after IPL treatment on the lower eyelid alone in patients with moderate-to-severe meibomian gland dysfunction (MGD). METHODS Patients who underwent four IPL treatment sessions with meibomian gland expression were divided into upper and lower treatment group and conventional treatment group treated with lower eyelid alone. All patients underwent an ophthalmologic examination and answered a symptom questionnaire before the first treatment and 1 month after the last treatment. An ophthalmologic examination included tear break-up time (TBUT), fluorescein staining score, Schirmer's test, matrix metalloproteinase-9 (MMP-9), meibum grade, color, consistency, and lid margin telangiectasia. Additionally, visual acuity and adverse effects were checked on every visit. RESULTS Of 115 patients, 75 in the upper and lower treatment group and 40 in the conventional treatment group were included. TBUT, fluorescein staining score, subjective symptom, and meibum grade were significantly improved in both groups. Additionally, meibum color and consistency of upper and lower eyelids significantly decreased post-treatment in both groups. The lid margin telangiectasia of the upper and lower eyelids significantly decreased post-treatment in the upper and lower treatment group. MMP-9 positivity and grading scores significantly decreased post-treatment in both groups, and no severe adverse effects occurred during the follow-up period. CONCLUSION Additional IPL treatment on the upper eyelid using a protective device was proven safe and provided an additive improvement in treating moderate-to-severe MGD.
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Ballesteros-Sánchez A, Gargallo-Martínez B, Sánchez-González MC, Sánchez-González JM. Intense Pulse Light Combined With Low-Level Light Therapy in Dry Eye Disease: A Systematic Review. Eye Contact Lens 2023; 49:8-13. [PMID: 36455215 DOI: 10.1097/icl.0000000000000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/11/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To evaluate the improvement in symptoms and signs associated with intense pulse light (IPL) combined with low-level light therapy (LLLT) in the treatment of dry eye disease (DED). METHODS A systematic review of full-length original studies reporting the effects of IPL combined with LLLT for DED in two databases, PubMed and Scopus, was performed according to the PRISMA statement. The quality assessment tool for case series studies from the National Heart, Lung, and Blood Institute was used to analyze the quality of the studies selected. RESULTS The search provided a total of 393 articles, of which six were included. Significant decreases in the Ocular Surface Disease Index (OSDI) score, meibomian gland dysfunction (MGD) score, MGD grade, and meiboscore and increases in tear film stability, lipid layer thickness, and loss area of the meibomian gland have been reported. Concerning tear volume, tear meniscus height, and Schirmer test remained unchanged. In relation to tear osmolarity and corneal fluorescein staining, contradictory outcomes were found. CONCLUSIONS Intense pulse light combined with LLLT for the treatment of dry eye improves OSDI, tear film stability, and meibomian gland function; thus, this treatment may be recommended for DED patients due to MGD.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Ophthalmology (A.B.S., B.G.M), Clínica Novovisión, Murcia, Spain; Department of Ophthalmology and Optometry (B.G.M.), University of Murcia, Murcia, Spain; and Department of Physics of Condensed Matter (J.M.S.G., M.C.S.G.), Optics Area, University of Seville, Seville, Spain
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Borgia A, Raimondi R, Fossati G, De Rosa FP, Romano V, Borroni D, Vigo L, Scorcia V, Giannaccare G. Device-based therapies as a boost of conventional treatment in dry eye disease. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2147928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alfredo Borgia
- Eye Unit, Humanitas-Gradenigo Hospital, Turin, Italy
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Raffaele Raimondi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Giovanni Fossati
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | | | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Luca Vigo
- Carones Ophthalmology Center, Milan, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
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Intense Pulse Light Therapy for Meibomian Gland Dysfunction. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Martínez-Hergueta MC, Alió del Barrio JL, Canto-Cerdan M, Amesty MA. Efficacy and safety of intense pulsed light direct eyelid application. Sci Rep 2022; 12:15592. [PMID: 36114213 PMCID: PMC9481572 DOI: 10.1038/s41598-022-17986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
To describe the efficacy and safety of intense pulsed light (IPL) applied directly on the eyelids of patients with Meibomian gland dysfunction (MGD) without corneal shield protector. Observational retrospective single centre study where patients underwent 3 treatment sessions of IPL with 2 weeks of interval. The IPL was carried out with Lumenis OPT M22 with a double pass technique of 12 impacts on the infraorbital/lower eyelid region with the 15 × 35 mm guide light (step 1) and a double pass technique of 3 impacts over the upper eyelids with the 8 × 15 mm guide light (step 2). The follow up was conducted through Oculus Keratograph 5 M. 30 patients were enrolled in the study. Although there were no significant differences (p > 0.05), non-invasive tear break-up time, ocular redness, and OSDI questionnaire improved during the 3 IPL sessions. A significant improvement (p = 0.024) in the percentage of meibomian gland loss was also observed. Regarding tear meniscus, it was found similar measurements before and after treatment. No serious adverse effects were reported during the procedure or in subsequent follow-up. Preliminary results suggest that IPL therapy applied directly on the eyelids without corneal shield could be safe and effective in the treatment of MGD.
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D'Souza S, Padmanabhan Nair A, Iyappan G, Dickman MM, Thakur P, Mullick R, Kundu G, Sethu S, Ghosh A, Shetty R. Clinical and Molecular Outcomes After Combined Intense Pulsed Light Therapy With Low-Level Light Therapy in Recalcitrant Evaporative Dry Eye Disease With Meibomian Gland Dysfunction. Cornea 2022; 41:1080-1087. [PMID: 34907942 DOI: 10.1097/ico.0000000000002954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Dry eye disease (DED) is a leading cause of ocular morbidity worldwide. This study evaluates the effects of combined light therapy [intense pulsed light (IPL) and low-level light therapy (LLLT)] on clinical and molecular outcomes in evaporative DED with meibomian gland dysfunction (MGD). METHODS This prospective study evaluated 94 eyes (47 subjects) with chronic MGD treated with combined light therapy. Patients underwent a detailed evaluation of MGD and DED using the Ocular Surface Disease Index, dry eye tests-tear breakup time and Schirmer test, ocular surface staining, meibomian gland expressibility scoring, and meibography. Patients underwent a single session of combined light therapy (IPL + LLLT treatment) using the Eye-light device. All these tests were repeated at 3 and 6 months after treatment. Tear fluid and ocular surface wash samples were collected from a subset of patients before and after treatment for cellular and secreted immune factor profiling by flow cytometry. RESULTS Combined light therapy (IPL + LLLT) demonstrated a marked improvement in the clinical metrics studied. Three months after treatment, Ocular Surface Disease Index showed a significant reduction in 95.6% ( P < 0.0001), tear breakup time increased in 72.3% ( P < 0.0001), and meibomian gland expressibility scoring increased in 80.8% ( P < 0.0001) of the eyes. These effects were observed to be sustained during the 6-month follow-up visit. Significant ( P < 0.05) reduction in tear fluid levels of interleukin-1β, interleukin-17F, and MMP9; MMP9/TIMP1 ratio; and ocular surface B-cell proportions was observed. CONCLUSIONS Combined light therapy shows promising results in patients with chronic MGD and DED, even in recalcitrant cases. Clinical and molecular factor alterations support the improved symptomatology and reduced inflammation.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | - Gowtham Iyappan
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Centre + MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Prashansa Thakur
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
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Caravaca A, Alió Del Barrio JL, Martínez Hergueta MC, Amesty MA. Intense pulsed light combined with meibomian gland expression for chalazion management. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:490-496. [PMID: 35787379 DOI: 10.1016/j.oftale.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. MATERIAL AND METHODS Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. RESULTS Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89±20.43 years were included. An average of 2.07±0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. CONCLUSIONS Combined IPL treatment for MGD/DED with IPL applied directly onto the eyelids and MGX could be effective and safe for the management of chalazions.
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Affiliation(s)
- A Caravaca
- Unidad de Oculoplastia, Vissum (Miranza Group), Alicante, Spain; Servicio de Oftalmología, Hospital General Reina Sofía, Murcia, Spain
| | - J L Alió Del Barrio
- Unidad de Córnea, Catarata y Cirugía Refractiva, Vissum (Miranza Group), Alicante, Spain; Departamento de Oftalmología, Universidad Miguel Hernández, Alicante, Spain
| | - M C Martínez Hergueta
- Departamento de Oftalmología, Universidad Miguel Hernández, Alicante, Spain; Servicio de Oftalmología, Hospital General de Elda, Alicante, Spain
| | - M A Amesty
- Unidad de Oculoplastia, Vissum (Miranza Group), Alicante, Spain.
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Li JX, Tsai YY, Lai CT, Li YL, Wu YH, Chiang CC. Lifitegrast Ophthalmic Solution 5% Is a Safe and Efficient Eyedrop for Dry Eye Disease: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:5014. [PMID: 36078948 PMCID: PMC9456613 DOI: 10.3390/jcm11175014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disease that causes ocular discomfort and visual impairment on a damaged ocular surface. Lifitegrast, a novel T-cell integrin antagonist, was approved in the United States in July 2016 as a 5% (50 mg/mL) ophthalmic solution for DED management. Currently, no meta-analysis and systemic review based on relevant studies have been conducted. This study aimed to evaluate the efficacy and safety of lifitegrast in patients with DED. We systematically searched Embase, Medline, PubMed, and Web of Science for randomized controlled trials (RCTs) and nonrandomized studies evaluating lifitegrast effects on symptomatic DED. Then, inferior corneal staining score, total corneal staining score (TCSS), nasal lissamine staining score (NLSS), total lissamine staining score, ocular discomfort score (ODS), eye discomfort score (visual analog scale (VAS) score), eye dryness score (EDS), ocular surface disease index score (OSDI-S), and tear break-up time (TBUT) were assessed. Clinical global impression and safety profiles were also evaluated. The studies were pooled in a random-effects model. We included five RCTs, one case-control study, and four longitudinal or retrospective studies, comprising 3197 participants. In the meta-analysis, lifitegrast was superior to the placebo because it improved TCSS, NLSS, TBUT, ODS, eye discomfort score, EDS, and OSDI-Sin DED. However, lifitegrast showed higher risks for ocular and non-ocular treatment-emergent adverse events (TEAEs) overall or at a mild or moderate level. Nonetheless, its incidence of adverse events slightly differed from that in the placebo, especially instillation site discomforts and dysgeusia, thereby considered safe and tolerable. Claims of withdrawal during follow-up caused by TEAEs were extremely rare. Lifitegrast improves DED, although dysgeusia, installation site pain, and irritation may be a concern for some. Overall, most of the adverse events are tolerable. Lifitegrast can alleviate refractory DED and improves patients' quality of life.
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Affiliation(s)
- Jing-Xing Li
- Department of General Medicine, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 406040, Taiwan
- Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei 100233, Taiwan
| | - Yi-Yu Tsai
- School of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- School of Medicine, National Taiwan University, Taipei 100233, Taiwan
| | - You-Ling Li
- School of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Ying-Hsuen Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Chun-Chi Chiang
- School of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
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Jiang X, Yuan H, Zhang M, Lv H, Chou Y, Yang J, Li X. The Efficacy and Safety of New-Generation Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction-Related Dry Eye: A Multicenter, Randomized, Patients-Blind, Parallel-Control, Non-Inferiority Clinical Trial. Ophthalmol Ther 2022; 11:1895-1912. [PMID: 35974296 PMCID: PMC9437192 DOI: 10.1007/s40123-022-00556-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction This study aimed to evaluate the efficacy and safety of a new-generation intense pulsed light (IPL) device in improving the symptoms and signs of meibomian gland dysfunction (MGD)-related dry eye, and compare it with a traditional IPL device. Methods This multicenter randomized controlled trial enrolled 132 patients with MGD-related dry eye from two centers. Patients were randomly assigned into the new-generation IPL (Eyesis) group or traditional IPL (E-Eye) group, and then blinded to receive treatment on days 0 and 7. Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer test, and meibomian gland signs were evaluated on days 0, 7, and 14. The primary outcome was defined as the effective rate of treating MGD at day 14. Any adverse events were recorded for safety assessment. Intergroup comparisons and non-inferiority analysis were performed. p values less than 0.05 were considered statistically significant. Results Basic information showed no significant difference between treatment groups. The intergroup difference of the effective rate was − 1.7% in the left eye and 1.6% in right eye, verifying the non-inferiority of the Eyesis device (p = 0.927). Significant improvements in OSDI, TBUT, Schirmer test, TMH, CFS, and meibomian gland signs were observed in Eyesis group on days 7 and 14 (all p < 0.05). Compared to the E-Eye group, the Eyesis group achieved more significant improvements in OSDI, TBUT, Schirmer test, TMH, and meibum quality (all p < 0.05). There was no significant difference in the incidences of adverse events between groups (p = 1.000). Conclusions The new-generation IPL was effective and safe in relieving the symptoms and signs of MGD-related dry eye, exhibiting a non-inferior effective rate compared to the traditional IPL. Additionally, Eyesis showed more clinical benefits over E-Eye in alleviating symptoms, increasing tear film stability and improving meibomian gland function. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00556-1.
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Affiliation(s)
- Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Yuan
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Mingzhou Zhang
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Huibin Lv
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yilin Chou
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China. .,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
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Yun J, Min JS. Skin temperature change in patients with meibomian gland dysfunction following intense pulsed light treatment. Front Med (Lausanne) 2022; 9:893940. [PMID: 36035434 PMCID: PMC9399455 DOI: 10.3389/fmed.2022.893940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose We investigated the change in skin temperature of treated areas during intense pulsed light (IPL) treatment in patients who have meibomian gland dysfunction (MGD) to determine whether there is superficial telangiectatic blood vessel ablation. Methods The medical records of 90 patients (90 eyes) with MGD who underwent IPL treatment were reviewed. The patients had undergone IPL treatment four times every 4 weeks. Ocular Surface Disease Index (OSDI) scores, dry eye (DE), and MGD parameters were obtained before the first and after the fourth IPL treatments. The skin temperatures of the upper and lower lids were measured before every IPL treatment. Results The skin temperatures of the lower lids were 31.89 ± 0.72°C at the first IPL (IPL#1), 30.89 ± 0.63°C at the second IPL (IPL#2), 30.14 ± 0.95°C at the third IPL (IPL#3), and 29.74 ± 0.87°C at the fourth IPL (IPL#4) treatments. The skin temperatures of upper lids were 32.01 ± 0.69°C at IPL#1, 31.13 ± 0.75°C at IPL#2, 30.34 ± 1.07°C at IPL#3, and 29.91 ± 0.76°C at IPL#4. The skin temperature of the upper and lower lids significantly decreased with every IPL treatment. Schirmer 1 test (ST) result was 12.97 ± 10.22 mm before IPL#1 and 14.45 ± 9.99 mm after IPL#4. Tear break-up time (TBUT) was 3.15 ± 1.38 s before IPL#1 and 5.53 ± 2.34 s after IPL#4. Corneal staining scores (CFS) was 1.61 ± 3.09 before IPL#1 and 0.50 ± 0.78 after IPL#4. Lipid layer thickness (LLT) was 71.88 ± 26.34 nm before IPL#1 and 68.38 ± 24.16 nm after IPL#4. Lid margin abnormality score (LAS) was 1.96 ± 0.62 before IPL#1 and 0.86 ± 0.67 after IPL#4. Meibum expressibility (ME) was 1.67 ± 0.87 before IPL#1 and 1.03 ± 1.67 after IPL#4. Meibum quality (MQ) was 18.18 ± 6.34 before IPL#1 and 10.16 ± 5.48 after IPL#4. OSDI was 35.38 ± 19.97 before IPL#1 and 15.48 ± 34.32 after IPL#4. OSDI scores, DE, and MGD parameters significantly improved after the fourth IPL treatment but not ST and LLT. Conclusion Our study showed that the occurrence of superficial telangiectatic vessels were indirectly reduced by the decrease in skin temperature accompanying IPL treatments in patients with MGD.
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Bzovey B, Ngo W. Eyelid Warming Devices: Safety, Efficacy, and Place in Therapy. CLINICAL OPTOMETRY 2022; 14:133-147. [PMID: 35959466 PMCID: PMC9362510 DOI: 10.2147/opto.s350186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Meibomian gland dysfunction (MGD) is characterized by the obstruction and/or inflammation of the meibomian glands that result in decreased and altered meibum secretion. This results in deficiencies in the tear film lipid layer which contributes to increased evaporation and destabilization of the tear film. One of the mainstay therapies for MGD is medical devices that apply heat and/or pressure to the eyelids and promote the liquification and outflow of meibum into the tear film. Over the past two decades, there have been a surge of interest in diagnosing and managing MGD. As a result, numerous medical devices have been developed and each have their own unique approach to treating MGD. This narrative review was conducted to summarize the current state of knowledge on eyelid warming devices, specifically warm eye coverings, devices that direct heat and/or pressure to the eyelids, moisture chamber goggles, and light-based therapy. This review summarized 58 human clinical studies and found that most eyelid warming devices were efficacious in improving signs and symptoms in a wide range of MGD severities and were generally safe to use.
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Affiliation(s)
- Brandon Bzovey
- Centre for Ocular Research & Education, School of Optometry & Vision Science University of Waterloo, Waterloo, Ontario, Canada
| | - William Ngo
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Eye and Vision Research (CEVR), Hong Kong, People’s Republic of China
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Vigo L, Pellegrini M, Carones F, Scorcia V, Giannaccare G. Outcomes of serial sessions of Activa mask combined with intense pulsed light therapy in patients with Meibomian gland dysfunction. BMC Ophthalmol 2022; 22:313. [PMID: 35854254 PMCID: PMC9295515 DOI: 10.1186/s12886-022-02538-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the effects on ocular surface signs and symptoms of serial sessions of heating and vibrating eye mask followed by intense pulsed light (IPL) therapy for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods Consecutive patients with MGD whose signs and symptoms were not satisfactorily controlled with conventional therapy were included. Patients received 3 treatments performed at day 1, 15, and 45 incorporating a session with a newly-developed eye mask (Activa, SBS Sistemi, Turin, Italy) immediately followed by IPL therapy (E > Eye device, E-Swin, Paris, France). Patients were examined before the first session (T0) and 30 days after the last session (T1) for the measurement of: noninvasive break-up time (NIBUT); lipid layer thickness (LLT); tear meniscus height (TMH); meibomian gland loss (MGL); tear osmolarity. Ocular discomfort symptoms were ascertained by ocular surface disease index (OSDI) questionnaire. Results Thirty patients were ultimately included in the study. At T1, all objective ocular surface parameters improved significantly, except for TMH: NIBUT and LLT increased from 6.4 ± 1.7 to 8.6 ± 1.7 s and from 57.7 ± 15.5 to 81.3 ± 12.0 μm (all P < 0.001), while MGL and tear osmolarity decreased from 21.1 ± 17.3 to 17.0 ± 14.1% and from 302.0 ± 8.5 to 295.7 ± 6.9 mOsm/L (respectively, P = 0.004 and P < 0.001). In parallel, OSDI score decreased significantly from 49.8 ± 13.5 to 29.8 ± 10.6 (P < 0.001). In the historical control group of patients who underwent only IPL, NIBUT, LLT, tear osmolarity and OSDI improved significantly but not MGL and TMH. Conclusions Serial sessions incorporating the application of an eye mask producing heating and vibration immediately followed by IPL therapy are able to improve all ocular surface parameters as well as ocular discomfort symptoms in MGD patients.
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Affiliation(s)
- Luca Vigo
- Carones Ophthalmology Center, Milan, Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | | | - Vincenzo Scorcia
- Department of Ophthalmology, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Germaneto (Catanzaro), Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Germaneto (Catanzaro), Italy.
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Xie L, Song W, Dong W, Li Y, Chen S, Sun X, Huang M, Cheng Y, Gao Y, Yang S, Yan X. Indirect Application of Intense Pulsed Light Induces Therapeutic Effects on Experimental Murine Meibomian Gland Dysfunction. Front Med (Lausanne) 2022; 9:923280. [PMID: 35721080 PMCID: PMC9201038 DOI: 10.3389/fmed.2022.923280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the indirect effects of intense pulsed light (IPL) on morphological and pathological changes of the meibomian glands (MGs) in apolipoprotein E knockout (ApoE–/–) mice and explore the underlying mechanisms. Methods ApoE–/– mice were treated with or without IPL three times below the lower eyelids and MGs were not directly exposed to irradiation. The eyelids and ocular surface were observed under a stereoscope. The morphology of MGs was examined by photographing and hematoxylin and eosin staining. Lipid droplets in MGs were examined by Oil Red O staining. The ultrastructure of meibocytes and mitochondria was observed under transmission electron microscopy. The relative gene and protein expression in MGs of upper eyelids was determined by immunostaining, Western blot, and qRT–PCR. Results Three IPL treatments decreased the toothpaste-like plugging of orifices and thickening and irregularity of the upper and lower eyelid margins in ApoE–/– mice. The morphology of some MGs improved after IPL treatments, accompanied by increased proliferation of acinar basal cells and decreased ductal keratinization. Furthermore, the accumulation of hyperchromatic lipid droplets in the acini increased, and the lipid droplets distributed in the cells around the acini were round and small. Compared with untreated ApoE–/– mice, oxidative stress and apoptosis were downregulated by IPL treatment, accompanied by the improvements in mitochondrial structure. Further research showed that IPL treatments reduced the levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-17A, IL-6 in MGs and inactivated nuclear factor kappa B (NF-κ B). Conclusion Collectively, the results demonstrate that indirect effects of IPL can improve the structure and function of MGs and mitigate the progression of MGD, which may be related to the indirect effects of photobiomodulation.
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Effect of thermoelectric warming therapy for the treatment of Meibomian Gland Dysfunction. Am J Ophthalmol 2022; 242:181-188. [DOI: 10.1016/j.ajo.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
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Chen C, Chen D, Chou YY, Long Q. Factors influencing the clinical outcomes of intense pulsed light for meibomian gland dysfunction. Medicine (Baltimore) 2021; 100:e28166. [PMID: 34889288 PMCID: PMC8663838 DOI: 10.1097/md.0000000000028166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Chen Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu-yu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qin Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Liu K, Chan YK, Peng X, Yuan R, Liao M, Liang J, Tang X, Xu Y, Cai Y, Li Q, Wang H. Improved Dry Eye Symptoms and Signs of Patients With Meibomian Gland Dysfunction by a Dietary Supplement. Front Med (Lausanne) 2021; 8:769132. [PMID: 34869485 PMCID: PMC8632949 DOI: 10.3389/fmed.2021.769132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To explore the therapeutic effect of a dietary supplement on dry eye with meibomian gland dysfunction (MGD). Methods: Sixty patients with MGD-related dry eye were included in this prospective and randomized, placebo-controlled study. All the subjects were treated with eye hot compress, artificial tears, and antibiotic ointment. After that, the patients received dietary supplementary or placebo daily for 12 weeks. The dry eye signs, function of MG, and visual quality of the patients were assessed at 4, 8, and 12 weeks after the treatment. Results: Twelve weeks after the treatment, patients who received dietary supplement had a significantly better improvement of dry eye symptoms, in terms of ocular surface diseases index and tear breaking-up time (TBUT), than those who received placebo (P < 0.05). The functions of MG, in terms of meibum quality and MG exclusion and MG obstruction scores, were significantly improved in both dietary supplement and placebo groups (P < 0.05). Patients who received dietary supplement had a significantly better improvement in the MG structure, in terms of acinar diameter and acinar density, than those who received placebo (P < 0.05). The number of inflammatory cells near MG was significantly lower in the dietary supplement group when compared with the placebo group (P < 0.05). The objective visual quality was significantly improved in the dietary supplement group, but not in the placebo group (P < 0.05). Conclusion: The dietary supplement can effectively improve the symptoms and signs of MGD-related dry eye, reduce the inflammatory reaction of MG, restore the gland structure, and indirectly improve the visual quality.
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Affiliation(s)
- Kangcheng Liu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yau Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xia Peng
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Ruolan Yuan
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Min Liao
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Jingwen Liang
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Xiangbo Tang
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yi Xu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Yingjun Cai
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Qiangxiang Li
- Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Hua Wang
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
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Short-Term Effects of a Novel Eye Mask Producing Heat and Vibration for the Treatment of Meibomian Gland Dysfunction: A Pilot Study. J Ophthalmol 2021; 2021:1370002. [PMID: 34457358 PMCID: PMC8387185 DOI: 10.1155/2021/1370002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose To investigate the short-term effects on tear film parameters and ocular symptoms of a novel eye mask producing heat and vibration developed for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods This is a pilot study including the first 20 consecutive patients (6 males, 14 females; mean age 52.4 ± 16.8 years) who were treated with a novel eye mask producing heat (42°) and vibration (up to 20 Hz) (Activa, SBS Sistemi, Turin, Italy) for 15 minutes. The treatment incorporates 2 phases in the following chronological order: 5 minutes of heating (phase I); 10 minutes of combination of heating and vibration (phase II). Noninvasive ocular surface examination was carried out before (T0) and 30 minutes after the mask session (T1) by means of Idra (SBS Sistemi, Turin, Italy) for the measurement of noninvasive break-up time (NIBUT) and lipid layer thickness (LLT). Patients' satisfaction after treatment was ascertained by asking the patients whether they perceived improvement from their baseline symptoms according to a 5-grade scale: none = 0; trace = 1; mild = 2; moderate = 3; high = 4. Results All patients completed regularly the mask session and no device-related adverse events were noted. NIBUT improved significantly from T0 to T1 (from 7.2 ± 1.8 s to 8.1 ± 2.1; P = 0.014). In parallel, also LLT improved from from T0 to T1 (72.5 ± 13.9 nm to 83.1 ± 16.1; P = 0.016). Seven patients (35% of the total) had a moderate satisfaction (grade 3) while 13 patients (65%) had a high satisfaction (grade 4) with treatment. Conclusions This eye mask represents a novel well tolerated tool in the armamentarium of MGD treatments. Thirty minutes after the session, NIBUT and LLT increased significantly; furthermore, all patients reported an improvement of discomfort symptoms with a moderate to high satisfaction with treatment.
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Abstract
PURPOSE OF REVIEW Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. RECENT FINDINGS Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SUMMARY Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
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Affiliation(s)
- Rhiya Mittal
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Naudin T, Thorel D, Tétart F, Muraine M, Gueudry J. [Combined Intense Pulsed Light and low-level light therapy in the treatment of Meibomian gland dysfunction]. J Fr Ophtalmol 2021; 44:1021-1028. [PMID: 34172298 DOI: 10.1016/j.jfo.2020.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Meibomian gland dysfunction (MGD) is the most common cause of dry eye syndrome. The goal of this study was to evaluate the efficacy of combined intense pulsed light (IPL) and low-level light therapy (LLLT) in symptomatic MGD. MATERIALS AND METHODS This retrospective study analyzed data from 30 patients with MGD causing dry eye symptoms not relieved by medical therapy and managed with combined IPL and LLLT. The primary endpoint was the Ocular Score Disease Index (OSDI) score at 1 month and 1 year. Secondary endpoints were visual acuity, intraocular pressure, tear film break-up time, Schirmer's test, Oxford score, and infrared meibographic score at 1 month after the conclusion of treatment. RESULTS The mean OSDI score decreased from 43±19 to 17±12 (1 month; p<0.0001) and then to 29±11 (12 months; p=0.013); 63% of patients were meibographic grade 2 before versus 7% after treatment (range, 1-4) (p=0.009); 75% of patients were Oxford grade 1 before versus 41% after treatment (p=0.004) (range, 1-3). No significant difference in the other secondary endpoints was noted. CONCLUSION Over time, IPL therapy in combination with LLLT appears to improve patients with symptomatic MGD resistant to medical therapy.
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Affiliation(s)
- T Naudin
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU Rouen, 76000 Rouen, France
| | - D Thorel
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU Rouen, 76000 Rouen, France
| | - F Tétart
- Service de dermatologie, hôpital Charles-Nicolle, CHU Rouen, 76000 Rouen, France
| | - M Muraine
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU Rouen, 76000 Rouen, France
| | - J Gueudry
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU Rouen, 76000 Rouen, France.
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Di Marino M, Conigliaro P, Aiello F, Valeri C, Giannini C, Mancino R, Modica S, Nucci C, Perricone R, Cesareo M. Combined Low-Level Light Therapy and Intense Pulsed Light Therapy for the Treatment of Dry Eye in Patients with Sjögren's Syndrome. J Ophthalmol 2021; 2021:2023246. [PMID: 34221491 PMCID: PMC8213457 DOI: 10.1155/2021/2023246] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/03/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate the effects of combined intense pulsed light therapy (IPL) and low-level light therapy (LLLT) in dry eye disease (DED) in patients affected by Sjögren's syndrome. Patients and Methods. This is a monocentric, prospective, interventional study. At baseline, all the study patients (n = 20) were on tear substitute therapy and underwent Schirmer type-1 test and breakup time (BUT) test. After baseline measurements, tear substitute therapy was suspended, and patients underwent IPL and LLLT. The same investigations were carried out at one (T1) and at three (T3) months after treatment. The Ocular Surface Disease Index (OSDI) survey was used to measure the severity of DED. RESULTS BUT test showed an increase in tear film breakup time in patients with DED 1 month after the beginning of the treatment (T0 vs T1: p=0,01). This increase was even more statistically significant after 3 months of the IPL and LLLT treatment (T0 vs T3: p < 0.0001). Schirmer test values increased too, but there was not statistically significance between values at T0 and T1 or T3. The patients perceived an improvement in their condition, which resulted in a lower score on the OSDI survey. The OSDI score was lower at T1 than T0 (T0 vs T1: p=0.0003), while it tended to increase again after 3 months although it was still lower than baseline (T0 vs T3: p=0.02). No facial or ocular side effects were reported. CONCLUSIONS The use of combined IPL/LLLT for the treatment of DED in patients affected by Sjögren's syndrome appears to be beneficial.
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Affiliation(s)
- Matteo Di Marino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Rome 00133, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Claudia Valeri
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Clarissa Giannini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Stella Modica
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Rome 00133, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Rome 00133, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
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Pérez-Silguero MA, Pérez-Silguero D, Rivero-Santana A, Bernal-Blasco MI, Encinas-Pisa P. Combined Intense Pulsed Light and Low-Level Light Therapy for the Treatment of Dry Eye: A Retrospective Before-After Study with One-Year Follow-Up. Clin Ophthalmol 2021; 15:2133-2140. [PMID: 34045848 PMCID: PMC8149274 DOI: 10.2147/opth.s307020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/20/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To assess the effectiveness of a combination of intense pulsed light and low-level light therapy (IPL/LLLT) for the treatment of dry eye. Study Design Retrospective before-after single-center clinical study. Materials and Methods Patients diagnosed with dry eye, refractory to conventional treatment, underwent four sessions of combined IPL/LLLT over 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, non-invasive breakup time (NIBUT), tear film osmolarity and meniscus height were measured 6 months before intervention, at baseline, post-intervention (3 months), 9 and 15 months. Results NIBUT, osmolarity and meniscus height significantly worsened during the 6 months before treatment, whereas symptoms did not change. OSDI scores significantly improved at post-intervention (MD = −44.0, 95% CI −38.1, −50.0), and then increased again until the at last follow-up, but still significantly different from baseline (MD = −30.0, 95% CI −23.4, −36.8). The three clinical signs showed a similar pattern, with one-year improvements of 3.6 seconds for the NIBUT (95% CI 3.1, 4.2, p <0.001), 28 mOsm/L for osmolarity (95% CI 23.6, 32.4, p <0.001) and 0.03 mm for meniscus height (95% CI 0.02, 0.04, p <0.001). No adverse effects were observed. Conclusion IPL/LLLT is safe and produces an important reduction in symptoms and signs of dry eye disease, still relevant one year after the end of treatment in a sample with high symptoms’ severity. Therefore, it represents a promising treatment option for patients who do not improve with conventional treatment. Randomized trials are needed to determine the added benefit provided by LLLT.
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Affiliation(s)
| | - David Pérez-Silguero
- Department of Ophthalmology, Pérez-Silguero Ophthalmologic Clinic, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Amado Rivero-Santana
- Department of Health Technology Assessment, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Maria Inmaculada Bernal-Blasco
- Department of Community and Family Medicine, Primary Care Center of Cuevas Torres, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Pablo Encinas-Pisa
- Department of Ophthalmology, La Paloma Hospital, Las Palmas de Gran Canaria, Canary Islands, Spain
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Aragona P, Giannaccare G, Mencucci R, Rubino P, Cantera E, Rolando M. Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. board review. Br J Ophthalmol 2021; 105:446-453. [PMID: 32703782 PMCID: PMC8005804 DOI: 10.1136/bjophthalmol-2019-315747] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
Dry eye disease (DED) is a growing public health concern affecting quality of life and visual function, with a significant socio-economic impact. It is characterised by the loss of homoeostasis, resulting in tear film instability, hyperosmolarity and inflammation of the ocular surface. If the innate immune response is unable to cope with internal bodily or environmental adverse conditions, the persistent, self-maintaining vicious circle of inflammation leads to the chronic form of the disease. Treatment of DED should be aimed at the restoration of the homoeostasis of the ocular surface system. A proper diagnostic approach is fundamental to define the relevance and importance of each of the DED main pathogenic factors, namely tear film instability, epithelial damage and inflammation. Consideration also needs to be given concerning two other pathogenic elements: lid margin changes and nerve damage. All the factors that maintain the vicious circle of DED in the patient's clinical presentation have to be considered and possibly treated simultaneously. The treatment should be long-lasting and personalised since it has to be adapted to the different clinical conditions observed along the course of the disease. Since DED treatment is frequently unable to provide fast and complete relief from symptoms, empathy with patients and willingness to explain to them the natural history of the disease are mandatory to improve patients' compliance. Furthermore, patients should be instructed about the possible need to increase the frequency and/or change the type of treatment according to the fluctuation of symptoms, following a preplanned rescue regimen.
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Affiliation(s)
- Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
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Gurnani B, Kaur K. Current approach in surgical management of dry eyes – Dry eye review II. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Intense pulsed light treatment in meibomian gland dysfunction: A concise review. Ocul Surf 2020; 18:583-594. [PMID: 32629039 DOI: 10.1016/j.jtos.2020.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To review the published literature related to application of intense pulsed light (IPL) for treating meibomian gland dysfunction (MGD). METHODS The literature search included the PubMed database and used the keywords "Intense Pulsed Light and Meibomian Gland Dysfunction". RESULTS IPL is a new instrumental treatment modality for MGD. This treatment modality was originally developed for use in dermatology and was later adopted in ophthalmology for treating MGD. IPL therapy for MGD can improve tear film stability, meibomian gland functionality, as well as subjective feeling of ocular dryness. However, in the reviewed literature, there was great variability in patient selection, evaluation criteria, and treatment protocols and durations. CONCLUSION Numerous studies report that IPL is effective for treating MGD and a safe procedure. There is great potential for further improvements to the procedure, as large comparative studies employing different treatment modalities are lacking.
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Wang MTM, Khatoon U, Craig JP. The use of intense pulsed light therapy in the treatment of refractory meibomian gland dysfunction. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1752666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Michael T. M. Wang
- Department of Ophthalmology, New Zealand National Eye Centre, the University of Auckland, Auckland, New Zealand
| | - Umaima Khatoon
- Department of Ophthalmology, New Zealand National Eye Centre, the University of Auckland, Auckland, New Zealand
| | - Jennifer P. Craig
- Department of Ophthalmology, New Zealand National Eye Centre, the University of Auckland, Auckland, New Zealand
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Suwal A, Hao JL, Zhou DD, Liu XF, Suwal R, Lu CW. Use of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease. Int J Med Sci 2020; 17:1385-1392. [PMID: 32624695 PMCID: PMC7330664 DOI: 10.7150/ijms.44288] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Dry Eye Disease (DED) is a common ocular condition that needs prompt diagnosis and careful treatment interventions. If left untreated, it can lead to numerous sight-threatening complications, including ulceration of the cornea, blepharitis, alterations of the tear film, conjunctivitis, and in severe cases, may lead to scarring, thinning, and even perforation of the cornea. Intense pulsed light (IPL) is a non-laser high-intensity light source that has shown to play a valuable role in dry eye disease. Recent evidence from various research works has shown that IPL modifies the mechanism of meibomian gland dysfunction (MGD), which helps to relieve the symptoms of DED. In this review, we demonstrated the mechanism of action of IPL, including its benefits on DED. The emerging evidence shows that the role of IPL in DED is novel and therapeutic. These results direct us to conclude that IPL is a potentially beneficial tool and essential future therapy for dry eye disease. Advances in the treatment of DED will lead to a better quality of life. However, tools to recognize potentially severe side effects of DED earlier in order to treat or prevent them must be developed.
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Affiliation(s)
- Abhishek Suwal
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Ji-Long Hao
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Dan-Dan Zhou
- Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Xiu-Fen Liu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Raja Suwal
- Department of Radiology, Koshi Zonal Hospital, Biratnagar, Province No. 1, Nepal
| | - Cheng-Wei Lu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
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