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Charles G Connor, Srihari Narayanan, William Miller; Reduction in inflammatory marker matrix metalloproteinase-9 following lid debridement with BlephEx. Invest. Ophthalmol. Vis. Sci. 2017;58(8):498.
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Meibomian Gland Disease (MGD) is a common cause of evaporative dry eye. Lid scrubs and warm compresses can address this problem but poor compliance makes an office based procedure desirable. Korb found the debridement-scaling of the lower lid margin provides statistically significant symptom relief and improvement in MG function. The BlephEx provides a method of accomplishing lid debridement without using a surgical instrument. Ocular surface inflammation is well documented in dry eye patients. The RPS InflammaDry recognizes elevated levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of dry eye patients. The purpose of this study is to determine if MMP-9 levels change following lid debridement with BlephEx.
Ten MGD patients (6 male, 4 female) with evaporative dry eye (Age range 25 to 57; mean age 30.25+/- 10.85) who tested positive on the RPS InflammaDry participated in this study. The OSDI, NITBUT and Meibography grading were performed just prior to BlephEx treatment. All tests were repeated four weeks post-BlephEx treatment. The RPS Inflammadry test was also performed pre-and post-BlephEx treatment. Data was analyzed by a t-test with post hoc test for significance.
All patients had a significant (p<0.01) reduction of symptoms four weeks after BlephEx treatment with baseline OSDI score reducing from 26 +/- 13.37 to 10.66 +/- 7.09. The NITBUT improved significantly (p<0.05) from a baseline of 6.99 +/- 2.37 seconds to 9.53 +/-2.41 seconds post-treatment. Meibography grades (Pult grading scheme; Oculus 5M Keratograph) did not change significantly (pre-treatment Grade 1.5 to grade 1.375 post-treatment). Most importantly, all ten subjects were negative for MMP-9 using the Inflammadry test at four weeks post-BlephEx treatment.
Subjects were over 50% less symptomatic and had a better NITBUT following BlephEx treatment. MMP-9 marker was negative for all subjects at four weeks post-BlephEx treatment. The betterment in symptoms can possibly be explained by the reduction in ocular surface inflammation. The results of this study suggest that debridement of the lid margin offers subjective and objective benefits to MGD patients.
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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