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Janell Renee Johnson, Waju Ali, Brian S. Wong, Mikhail de Jesus, Richard W Yee; Topical Spironolactone in the Treatment of Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2249.
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© ARVO (1962-2015); The Authors (2016-present)
Conventional treatments for dry eye syndrome have focused on addressing tear levels and inflammation, but have failed to demonstrate efficacy in all patients. New therapies have increasingly addressed meibomian gland dysfunction (MGD). This study tested the hypothesis that topical spironolactone can aid in the treatment of MGD by regulating and improving sebaceous gland meibum secretions through a variety of mechanisms in both patients with and without aqueous tear deficiency.
We performed a retrospective, observational clinical study of 102 patients with moderate to severe MGD from Nov. 2014 to May 2016. These patients were split into two cohorts: the first cohort included 75 patients with Schirmer’s tear test (STT) scores greater than 5 and at least 1 follow-up after 1 month and the second cohort included 27 patients with STT of 5 or less and at least 1 follow-up after 1 month. Both cohorts were monitored for changes in subjective global dry eye assessment, keratitis and conjuctival staining, anterior blepharitis grade (AB), gland obstruction grade (O), meibum turbidity grade (T), vascularization of the anterior lid margin (V), zone A posterior lid margin grade, best corrected vision, and STT score. These parameters were compared in a pre-post study.
At the first follow-up, the 75 patients in the first cohort had statistically significant improvements in self-reported global assessment scores (p<0.0001), V scores (p=0.0009), O scores (p=0.0011), T scores (p<0.0001), and Zone A scores (p<0.0001). At the first follow-up, the 27 patients in the 2nd cohort had statistically significant improvements in self-reported global assessment scores (p=0.030), V scores (p=0.0056), T scores (0=0.0005), Zone A scores (p=0.0199), and STT (p=0.0324 OD, p=0.0096 OS).
In both cohorts at the 1st follow-up, patients reported improved dry eye symptoms after using spironolactone. The quality of expressed meibum secretions showed clinical improvement of clarity and viscosity post-treatment. Inflammation decreased at the avascular region ~0.5 mm posterior to the posterior lid margin. Patients with low STT prior to treatment showed increased tear quantity. Ultimately, this retrospective study demonstrates the potential for spironolactone to significantly regulate meibum quality and address inflammation in treating moderate to severe MGD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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