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Gary N. Foulks, Douglas Borchman, Marta C. Yappert; Comparative Effectiveness Of Azithromycin And Doxycycline In Therapy Of Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3816.
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To determine effectiveness of topical azithromycin versus oral doxycycline therapy of meibomian gland dysfunction both clinically and through spectroscopic analysis of meibum.
Subjects with meibomian gland dysfunction were assigned to either topical azithromycin therapy (1 mo) or oral doxycycline therapy (2 mo). Clinical evaluation of signs and symptoms was performed according to categorical scales. Mechanical expression of the meibomian glands of all subjects was done before and after therapy with topical azithromycin or oral doxycycline. Expressate was analyzed by Fourier Transform Infrared (FTIR) spectroscopy, MALDI-TOF spectroscopy, and nuclear magnetic resonance spectroscopy (NMR). Measurement of lipid structure and behaviour was determined for each subject and compared with respect to therapy. Statistical analysis of groups used two-sided Student T-test with p<0.05 for significance.
All subjects were found to have abnormal lipid structure and function prior to therapy with evidence of increased lipid ordering (% trans rotamer) and higher phase transition temperature than normals. Twenty-two subjects were treated with topical azithromycin solution with reduction of the abnormal lipid behavior measured at 2 and 4 weeks of treatment. Seven subjects were treated with oral doxycycline with reduction of lipid abnormality but with a longer response time and less vigorous response compared to azithromycin therapy. Intolerance of medication was greater with doxycycline.
Both topical azithromycin and oral doxycycline improve clinical signs and symptoms of meibomian gland dysfunction but response to azithromycin is more rapid and more robust than doxycycline. The behavior of lipids of the meibomian glands is improved by both drugs but in a more rapid and robust manner with azithromycin.
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