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Joanne F Shen, Srav Vegunta, Qing Wu, Dharmendra (Dave) Patel, Nandita Khera; Intense pulsed light (IPL) and meibomian gland expression (MGX) treatment of ocular rosacea and dry eye disease (DED) in chronic graft-versus-host disease (cGVHD): 12 month pilot study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4441.
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Evaluate tolerability and efficacy of IPL and MGX treatment for severe DED and ocular rosacea in allogeneic hematologic stem cell transplantation (allo-HSCT) subjects with controlled cGVHD in a prospective 12 month pilot study.
Nine subjects status post all-HSCT with controlled cGVHD and severe DED and ocular rosacea were prospectively examined and treated with IPL and MGX as previously described by Toyos using the DermaMed system under approved institutional review board protocol. Subjects were evaluated by a single ophthalmologist with SPEED2 (scaled from 0-28) and OSDI symptom surveys, visual acuity, intraocular pressure, slit lamp examination with meibomian gland evaluation (MGE), lissamine green and fluorescein vital dye staining, Schirmer’s testing, lipid tear film analysis, tear osmolarity, tear meniscus height, infrared meibomography, and tear break up time at baseline, 1, 2, 3, 4, 5, 9 and 12 months post-treatment. Subjects received IPL and lid expression at baseline, months 1, 2, and 3.
The average subject age was 47 years, with 5 women and 4 men. One male subject developed active systemic GVHD and had to withdraw from the study. Of the remaining 8 subjects, the mean baseline SPEED2 score was severe at 20.7 (range 17-25). By 5 months after starting IPL/MGX series, the mean SPEED2 significantly improved an average of 8.0 points (paired t-test, p=0.003). At 12 months, this symptom improvement was sustained with an average of 8.0 points (paired t-test, p<0.001). However, MGE quantifying the total number of meibomian glands producing liquid secretions, tear osmolarity, and meibomography showed no change from baseline to 12 months.
DED in cGVHD is multifactorial with abnormalities in aqueous as well as meibum production. Novel approaches for treating this severe form of dry eye is needed to improve quality of life for these patients. This pilot study shows tolerability of IPL/MGX treatment with prolonged symptomatic improvement of dry eye symptoms, but no physical correlation of improvement. This pilot study is limited by lack of case controls and single observer bias. However, the significant symptom improvement in this cohort warrants further investigation under a clinical trial to evaluate IPL as an adjuvant treatment in cGVHD patients with dry eye symptoms.
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