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David Rooney, Jen Hong Tan, U Rajendra Acharya, Hwee Kuan Lee, Zhao Yang, Markus Wenk, Louis Tong, Collaborative Research Initiative for Meibomian gland dysfunction (CoRIM); Thermal pulsation for meibomian gland dysfunction in Asian patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):46.
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Dry eye and meibomian gland dysfunction (MGD) are prevalent ocular surface conditions with no satisfactory treatment. Recently LipiFlow, a form of thermopulsation treatment, has been advocated. We aimed to evaluate the efficacy and safety of LipiFlow in Asian patients with dry eye and MGD.
This is a hospital-based longitudinal interventional study of LipiFlow compared to conventional warm compress treatment. Patients without systemic diseases were recruited. Symptom evaluation and ocular examination for dry eye were performed before treatment as well as 1 and 3 months after treatment. Examination included corneal fluorescein staining, fluorescein tear break-up time, slitlamp examination, meibombian gland expression, tear lipid thickness, Schirmer test, visual acuity, and tonometry. During the study period 25 patients underwent a single 12-minute session of LipiFlow treatment in clinic, and 24 patients underwent 10-minute warm compress treatment twice daily. Blephagel lid hygiene was used liberally in both study arms.
The average age of patients was 56.2 years (SD:11.7) with 12 men and 37 women, reflecting the clinic’s patient profile. Age and gender composition of participants in the two arms was similar (p>0.05). There was no significant difference in the arms’ baseline characteristics except for corneal fluorescein staining, which was more severe in all corneal zones of the conventional arm (p<0.05) except for the central zone (p=0.12). Overall, there was significant decrease in symptoms after either treatment (p=0.006) and a trend for greater reduction in patients treated by LipiFlow, but this trend was not significant (p=0.056). Tear break up time was significantly improved at 4 weeks (p=0.048) and at 12 weeks (p=0.028) with LipiFlow but not with conventional treatment (p>0.05). The reduction of central corneal staining was greater with LipiFlow than with conventional treatment up to 12 weeks after treatment (OR 0.31, 95% CI 0.14-0.68), a difference that remained significant after adjustment for age and sex. There was no significant difference in staining of all four other corneal zones. No adverse effects were noted with either treatment.
LipiFlow treatment is similar to warm compress treatment in terms of efficacy and safety. However, because LipiFlow is much more convenient (1 time treatment) and avoids non-compliance issues, it may be advantageous for clinical use.
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