Clinical Experience of Intense Pulse Light Therapy Along With Meibomian Gland Expression in Patients With Meibomian Gland Dysfunction: A Retrospective Study

TL;DR

This study found that IPL therapy combined with MGX significantly improved dry eye symptoms and lipid layer thickness in patients with MGD, with no reported side effects.

Contribution

The study provides clinical evidence of the effectiveness of IPL with MGX in treating MGD-related dry eye symptoms.

Findings

OSDI scores significantly decreased by 7.27 points from baseline to the final follow-up.

Lipid layer thickness improved, with a significant increase in eyes with thickness ≥80 nm.

No side effects were reported among patients undergoing IPL and MGX treatments.

Abstract

Introduction: Intense pulsed light (IPL) therapy alone or along with meibomian gland expression (MGX) is one of the therapies for the management of dry eye symptoms associated with meibomian gland dysfunction (MGD). The present study was conducted to assess changes in dryness of the eyes, as assessed by ocular surface disease index (OSDI) scores, and lipid layer thickness in patients with MGD treated with IPL along with MGX. We also evaluated the side effects of IPL treatment in these patients.

Methods: This study was a retrospective secondary longitudinal data analysis of 200 eyes of 100 patients with MGD and symptoms of dry eye. They were treated with three sessions of IPL along with MGX at a tertiary eye care center in India. We abstracted data from 100 patients who presented to the clinic, were clinically diagnosed with MGD, underwent three sessions of IPL therapy (with a 15-day gap between sessions), and were followed up for evaluation 30 days after the last treatment. The following parameters were included in data abstraction: demographics (age, gender) and clinical parameters (complaints, symptoms, comorbidities, current treatment). The main outcomes were as follows: OSDI score and change in OSDI scores; lipid layer thickness category at each visit and change in lipid layer thickness; and side effects after IPL sessions. Multiple eyes from the same patient were accounted for using mixed-effects models for multivariate analysis.

Results: The mean (SD) age of the patients was 65.2 (9.7) years, with 52 females and 48 males. At baseline, the proportion of eyes with a lipid layer thickness value of ≤15 nm was 24% (n = 48), a value of 30 nm was 45% (n = 90), a value of 30-80 nm was 19% (n = 38), and a value of ≥80 nm was 12% (n = 24). There was an improvement in lipid layer thickness at each visit, and by the last follow-up, the proportions had changed to 23% (n = 46) for ≤15 nm, 33.5% (n = 67) for 30 nm, 18.5% (n = 37) for 30-80 nm, and 25.0% (n = 50) for ≥80 nm; this change was statistically significant (p < 0.01). The mean ± SD OSDI score at baseline was 14.62 ± 9.73. It reduced to 11.07 ± 8.41 on day 15 and was 7.35 ± 6.80 at the last follow-up. The mean change from baseline to day 60 was −7.27 ± 7.19, which was statistically significant (p < 0.001). In multivariate mixed-effects models, we found a significant reduction in the OSDI score at every follow-up visit (estimate: −2.34, 95% CI: −2.60 to −2.07, p < 0.001). None of the patients reported any side effects.

Conclusions: There was a reduction in OSDI scores at the last follow-up visit compared with the values before the first session of IPL in this retrospective study. We also observed a significant reduction in OSDI scores after each session of IPL and MGX. Moreover, there was a significant increase in the proportion of eyes with higher lipid layer thickness at the final follow-up visit, indicating improvement in lipid layer thickness. The IPL sessions were well tolerated, with no reported side effects.

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