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Craig Schallhorn, Steven C Schallhorn, Julie Marie Schallhorn; Effectiveness of an eyelid thermal pulsation procedure to treat recalcitrant dry eye symptoms after refractive surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3694.
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© ARVO (1962-2015); The Authors (2016-present)
To provide an initial retrospective evaluation of the effectiveness of a thermal pulsation system to treat post-refractive surgery dye eye refractory to conventional therapy.
A total of 169 eyes of 91 patients underwent thermal pulsation therapy (Lipiflow, Tear Sciences, Morrisville, NC) for the treatment of post-operative dye eye that were not well controlled with conventional treatment. Pre-therapy measurements were conducted on the tear film lipid layer (Lipi score) and meibomian gland function (MFE). A standard dry eye questionnaire was administered to all patients before and after thermal pulse therapy to evaluate dry eye symptoms (SPEED II).
The mean patient age was 51 ± 13.0 yrs, 66% were female, and their primary refractive procedure was either laser vision correction (72% LASIK / 11% PRK) or a refractive lens exchange (17%). They underwent thermal pulsation therapy a mean of 43.8 ± 23.0 months after their primary procedure. Pre-therapy Lipi score was 68.2 ± 23.4 OD, 70.6 ± 22.6 OS. Pre-therapy MGE was 4.4 ± 2.0 OD, 4.8 ± 2.1 OS. Mean pre-therapy SPEED II questionnaire score was 17.6 ± 7.6, with a reduced mean post-therapy score of 9.4 ± 5.1 (P<0.001). This statistically significant reduction in SPEED II questionnaire score correlated with an improvement in dry eye clinical findings. Symptoms were reported as “improved” in 42% of patients, with symptoms being reported as “worse” in 8%. Fifteen patients (27 eyes) reported that the effect of the therapy had worn off at a mean post-therapy time of 12.8 ± 12.0 weeks.
Management of recalcitrant dry eye after refractive surgery is often challenging with limited treatment options currently available. In this initial retrospective evaluation, a significant improvement in patient reported dry eye symptoms (mean pre to post-therapy change of 8.2 points) was observed following thermal pulsation therapy. However, within 6 months of treatment, the effect diminished in a subset of patients. Additional studies are needed to evaluate this treatment modality, including prospective, masked studies with a control population as well as an evaluation of the long-term efficacy.
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