Abstract
Purpose :
To assess TGFβ and ocular microbiome changes after Intense Pulsed Light with Meibomian Gland Expression (IPL-MGX) vs MGX alone for dry eye symptoms from meibomian gland disease and ocular rosacea.
Methods :
Twenty patients with ocular rosacea and dry eye disease (DED) were randomly assigned to a series of MGX alone or IPL-MGX in a pilot prospective clinical trial. Treatment occured once every 4-6 weeks over a 20-24 week period. Tear samples obtained by capillary tube collection and conjunctival impression cytology specimens were collected at first and last visits and analyzed for transforming growth factor-beta (TGFβ) concentrations, and ocular microbiome 16S rRNA gene amplicon sequencing. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline between treatment groups.
Results :
In the right eye, IPL-MGX patients had a median TGFβ1 increase of 1.9 and a median TGFβ2 increase of 1.2. Conversely, MGX patients had decreased TGFβ1 and TGFβ2 concentrations (-7.8 and -6). Despite observed differences between treatment groups, statistical significance was not reached due to small sample size (TGFβ1 p=0.417, TGFβ2 p=0.459). Right eye TGFβ3 decreased in both groups. In the left eye, a median TGFβ1 increase of 7.7 was observed in IPL-MGX patients, compared to a median decrease of 1.4 in MGX patients (p=0.766). Left eye TGFβ2 and 3 decreased in both groups. Microbiome analysis revealed statistically significant reduction from baseline in Haemophilus (p=0.0156), Brevibacterium (p=0.0322), and Actinomyces (p=0.0313) in the right eye and Klebsiella (p=0.0117) in the left eye of both IPL-MGX and MGX groups.
Conclusions :
To our knowledge TGFβ in tears has not been studied before. It is possible that tear film may not accurately reflect TGFBβ upregulation, as previous dermatologic studies revealing upregulated TGFβ after IPL utilized skin biopsies. Our data, although not statistically significant due to small cohort, suggests that TGFβ1 may be involved in the mechanism of action of IPL in DED, and that IPL-MGX cotreatment may have an additive or synergistic effect. Interestingly, our previous work on this cohort also found improved patient-reported outcomes of DED in the IPL-MGX group. Future investigation should prioritize high sample volume and larger cohort size.
This is a 2020 ARVO Annual Meeting abstract.