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Eddie Y Liu, Monali Malvankar, Sera Thomas, John Costella, Cindy M L Hutnik; Systematic review and meta-analysis on the efficacy of LipiFlow® device in the treatment of Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4433. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the effectiveness of LipiFlow® in the treatment of Meibomian gland dysfunction (MGD).
Published and unpublished scientific work from January 1, 2000 to July 15, 2014 were systematically reviewed using bibliographic databases (MEDLINE, EMBASE, BIOSIS Previews, CINAHL, HEED, ISI Web of Science and Cochrane Library) and grey literature by key words and search strategies. Potential studies were screened by two independent reviewers according to the following inclusion criteria: 1) research studies 2) human subjects older than 19 year of age with dry eyes and 3) treated with LipiFlow® or a similar thermal pulsation device. Downs and Black checklist was used to assess study quality. Data was extracted by 2 independent reviewers from 13 eligible articles. Standardized mean difference (SDM) was computed as the effect size. Effect sizes were calculated for meibomian gland excretion (MG) score, tear break-up time (TFBUT), SPEED and OSDI questionnaires.
Up to 3 months after a single LipiFlow® treatment, significant improvement from baseline measures were seen in MG scores (SMD 1.64, 95% CI: 1.42, 1.85), TFBUT (SMD 0.62, 95% CI: 0.42, 0.83), SPEED (SMD -1.15, 95% CI: -1.36, -0.95) and OSDI (SMD -0.81, 95% CI: -1.01, -0.60). Single study data also showed the following significant improvement: up to 48 months after a single Lipiflow® treatment significant improvement was seen in MG score (SMD 2.68, 95% CI: 1.77, 3.59); 3 month following MeiboPatch® compress with massage treatment significant improvement was seen in MG score (SMD 0.63, 95% Cl: 0.02, -0.81), SPEED (SMD -1.02, 95% Cl: -1.01, 0.30) and OSDI (SMD - 0.75, 95% Cl: -1.37, -0.13); 3 month after warm compress with massage treatment significant improvement was seen in MG score (SMD 0.91, 95% Cl: 0.36, 1.46); and 2 weeks after iHeat® treatment significant improvement was seen in OSDI (SMD - 0.41, 95% Cl: -0.65, -0.18).
Lipiflow® is an effective treatment option of MGD. It improves objective and subjective measures of dry eye symptoms up to 3 months after a single Lipiflow treatment. Further studies are needed to confirm the effectiveness at and beyond 1 year after treatment.<br /> Ultimately, the cost-effectiveness of Lipiflow® treatment in the management of MGD will determine its clinical applicability.
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