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Joanne F Shen; Pilot study of intense pulsed light (IPL) for improvement of severe dry eye symptoms in subjects with ocular rosacea related to inactive graft-versus-host disease (GVHD). Invest. Ophthalmol. Vis. Sci. 2014;55(13):2017.
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Evaluate efficacy of IPL treatment for dry eye symptoms and meibomian gland disease from ocular rosacea in bone marrow transplant subjects with inactive GVHD in a prospective pilot study.
5 subjects status post bone marrow transplant with inactive GVHD with ocular rosacea, meibomian gland dysfunction, and severe dry eye symptoms were prospectively examined and treated with IPL and lid expression under approved institutional review board (IRB) protocol. Subjects' GVHD was deemed inactive by the treating hematologist. All subjects had failed to respond to conventional therapies. Subjects were evaluated by a single ophthalmologist with SPEED2 and OSDI symptom surveys, visual acuity, intraocular pressure, slit lamp examination with lissamine green and fluorescein vital dye staining, Schirmers testing, lipid tear film analysis, tear osmolarity, tear meniscus height, infrared meibomography,and tear break up time at baseline, 1, 2, 3, 4, 5, and 6 months post treatment. Subjects received IPL and lid expression at baseline, months 1, 2, and 3.
The average patient age was 47 years. The group included 2 women and 3 men. At 1 month followup after one treatment of IPL, 2 of the 5 subjects reported improved symptoms with an average of 32.25% improvement in SPEED2 scores and 66.6% improvement in OSDI scores. 4 of the 20 eyes (20%) showed improvement of meibomian gland expression. 4 of 10 eyes (40%) demonstrated stable or improved Schirmers testing. 6 of 10 eyes (60%) showed improvement of lipid tear film thickness. All eyes showed gland abnormalities on infrared meibomography confirming meibomian gland dysfunction.
Dry eye in GVHD is multifactorial in deficiency in aqueous production as well as meibum quality and quantitative production. A multifactorial approach for treating this severe form of dry eye is needed to improve quality of life for these bone marrow transplant patients. This pilot IPL study shows initial symptomatic improvement of dry eye symptoms in 60% patients with GVHD after BMT. This pilot study is limited by small sample size, lack of case control, and single observer bias. However, the improvement found in some subjects warrants further investigation under a clinical trial to evaluate IPL as an adjunct treatment of ocular rosacea in quiescent GVHD patients with dry eye symptoms.
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