Intense pulsed light therapy with meibomian gland expression vs meibomian gland expression for treatment of dry eye in ocular rosacea

Abstract

Purpose : Retrospective research suggests the benefit of Intense Pulsed Light with Meibomian Gland Expression (IPL-MGX) in patients with ocular rosacea and dry eye disease (DED). However current literature is lacking prospective analysis of IPL-MGX. A prospective, randomized pilot study was undertaken to compare symptomatic and clinical results of treatment of ocular rosacea and dry eye with IPL-MGX versus MGX alone.

Methods : 20 patients with ocular rosacea and DED were randomly assigned to either a series of IPL-MGX or MGX only and then examined and treated every 4-6 weeks for 4 total treatments. Demographic variables and pre-treatment measures were captured at baseline. Ocular Severity Disease Index (OSDI) and World Health Organization Quality of Life (WHO-QOL) surveys as well as clinical measures of dryness were captured at baseline and before each follow-up treatment cycle. Change from baseline was compared between treatment groups using the Wilcoxon sign rank test. Generalized linear models were fit to the longitudinal outcomes and compared between groups.

Results : By the 4^th visit, OSDI scores were significantly improved from baseline in the IPL-MGX treatment group compared to MGX alone (p=0.03). The number of meibomian glands yielding liquid secretions (MGYLS) increased in both groups. The increase was greater in the IPL-MGX group though not achieving statistical significance in the small sample size. No significance was detected between the two groups in WHO-QOL scoring, fluorescein staining, lissamine green staining, bulbar redness score, matrix metallopeptidase-9 expression (MMP-9), Schirmers testing, or percentage of atrophy on infrared meibography.

Conclusions : Patients treated with IPL-MGX showed symptomatic improvement of dry eye symptoms over MGX alone in ocular rosacea patients. A placebo effect cannot be ruled out in contributing to this improvement in symptoms. The exact etiology of the benefit of IPL addition to MGX is not known. Prospective studies on IPL-MGX with larger sample size are needed to elucidate this mechanism.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1: Mean change in OSDI over time for treatment groups MGX as compared to IPL-MGX