Effect of IPL in Patients with Meibomian Gland Dysfunction

Abstract

Purpose To evaluate the effect of IPL (intense pulsed light) treatment in patients with meibomian gland dysfunction (MGD).

Methods Clinical data of 25 patients with MGD who underwent IPL treatment at the department of ophthalmology of Ludwig-Maximilians-University between 2016 and 2018 were analyzed. Demographics, clinical history, examination findings (eyelid vascularization, meibomian gland findings, conjunctival redness, tear film break-up time [TFBUT], corneal staining (Oxford grading scale [OGS]), and subjective patientsʼ findings (including ocular surface disease index [OSDI]) were collected from each visit (D1, D15, D45, D75).

Results All included patients underwent three sessions of IPL treatment in both eyes (D1, D15, D45). There was a significant improvement after IPL treatment (D75) in TFBUT (p < 0.001), corneal staining (OGS) (p < 0.001), conjunctival redness (p < 0.001), lid margin edema (p < 0.001) and redness (p < 0.001), meibum quality (p < 0.001), lid margin telangiectasia (p = 0.005), meibomian gland obstruction (p = 0.001), and OSDI score (p = 0.004). Even after the first IPL session, significant improvements in TFBUT (p < 0.001), corneal staining (OGS p < 0.001), conjunctival redness (p < 0.022), lid margin edema (p < 0.001) and redness (p < 0.016), meibum quality (p = 0.014), and OSDI score (p < 0.013) were noted. There were no relevant negative side effects. Subgroup analysis for age, sex, duration or severity of disease, and associated diagnosis of rosacea showed no significant difference in effectiveness.

Conclusion IPL is an effective and safe treatment for patients with MGD, which can be used as a supportive therapeutic option.

Zusammenfassung

Ziel Beurteilung der Wirkung der IPL-Therapie (IPL: Intensive pulsed Light) bei Patienten mit Meibomdrüsendysfunktion (MDD).

Methoden Analysiert wurden die Daten von 25 Patienten mit MDD, die zwischen 2016 und 2018 in der Abteilung für Augenheilkunde der LMU mittels IPL behandelt wurden. Demografische Daten, klinische Anamnese sowie Untersuchungsbefunde (Lidrandvaskularisation, Meibomdrüsenbefunde, Bindehautrötung, Tränenfilmaufrisszeit (TFBUT), Hornhautoberflächenfärbung (Oxford Grading Scale [OGS]) und subjektive Symptome (einschließlich des Ocular Surface Disease Index [OSDI]) wurden bei jedem Besuch erhoben (D1, D15, D45, D75).

Ergebnisse Alle Patienten erhielten eine IPL-Behandlung in 3 Sitzungen an beiden Augen (D1, D15, D45). Am Ende der IPL-Behandlung (D75) zeigte sich eine signifikante Verbesserung von TFBUT (p < 0,001), Hornhautoberflächenfärbung (OGS) (p < 0,001), Bindehautrötung (p < 0,001), Lidrandödem (p < 0,001) und Lidrandrötung (p < 0,001), Meibumqualität (p < 0,001), Lidrandteleangiektasien (p = 0,005), Meibomdrüsenobstruktion (p = 0,001) und OSDI-Score (p = 0,004). Bereits nach der 1. IPL-Sitzung konnte eine signifikante Verbesserung von TFBUT (p = 0,001), Hornhautoberflächenfärbung (OGS p < 0,001), Bindehautrötung (p = 0,022), Lidrandödem (p = 0,001) und -rötung (p = 0,016), Meibumqualität (p = 0,014) und OSDI-Score (p = 0,013) festgestellt werden. Es gab keine relevanten negativen Nebenwirkungen. Eine Subgruppenanalyse hinsichtlich Alter, Geschlecht, Dauer oder Schwere der Erkrankung sowie der assoziierten Diagnose der Rosazea zeigte keinen signifikanten Unterschied in der Wirksamkeit.

Schlussfolgerung IPL ist eine wirksame und sichere Behandlung für Patienten mit MGD, die als unterstützende therapeutische Option eingesetzt werden kann.

Key words

IPL - Meibomian gland dysfunction - dry eye - light impulse - intensive pulsed light

Schlüsselwörter

IPL - Meibomdrüsendysfunktion - trockenes Auge - Pulslichttherapie - Intensive pulsed Light

• References

• 1 Schaumberg DA, Nichols JJ, Papas EB. et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011; 52: 1994-2005 doi:10.1167/iovs.10-6997e
• 2 Messmer EM. The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl Int 2015; 112: 71-81 quiz 82 doi:10.3238/arztebl.2015.0071
• 3 Chia EM, Mitchell P, Rochtchina E. et al. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Experiment Ophthalmol 2003; 31: 229-232
• 4 Nelson JD, Shimazaki J, Benitez-del-Castillo JM. et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 2011; 52: 1930-1937 doi:10.1167/iovs.10-6997b
• 5 Romero JM, Biser SA, Perry HD. et al. Conservative treatment of meibomian gland dysfunction. Eye Contact Lens 2004; 30: 14-19 doi:10.1097/01.ICL.0000095229.01957.89
• 6 Jones L, Downie LE, Korb D. et al. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15: 575-628 doi:10.1016/j.jtos.2017.05.006
• 7 Craig JP, Blades K, Patel S. Tear lipid layer structure and stability following expression of the meibomian glands. Ophthalmic Physiol Opt 1995; 15: 569-574
• 8 Bilkhu PS, Naroo SA, Wolffsohn JS. Effect of a commercially available warm compress on eyelid temperature and tear film in healthy eyes. Optom Vis Sci 2014; 91: 163-170 doi:10.1097/OPX.0000000000000134
• 9 Geerling G, Tauber J, Baudouin C. et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2011; 52: 2050-2064 doi:10.1167/iovs.10-6997g
• 10 Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg 2015; 33: 41-46 doi:10.1089/pho.2014.3819
• 11 Schuh A, Priglinger S, Messmer EM. [Intense pulsed light (IPL) as a therapeutic option for Meibomian gland dysfunction]. Ophthalmologe 2019; 116: 982-988 doi:10.1007/s00347-019-00955-z
• 12 Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2015; 56: 1965-1970 doi:10.1167/iovs.14-15764
• 13 Gupta PK, Vora GK, Matossian C. et al. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease. Can J Ophthalmol 2016; 51: 249-253 doi:10.1016/j.jcjo.2016.01.005
• 14 Jiang X, Lv H, Song H. et al. Evaluation of the Safety and Effectiveness of Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction. J Ophthalmol 2016; 2016: 1910694 doi:10.1155/2016/1910694
• 15 Papageorgiou P, Clayton W, Norwood S. et al. Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results. Br J Dermatol 2008; 159: 628-632 doi:10.1111/j.1365-2133.2008.08702.x
• 16 Kalangara JP, Galor A, Levitt RC. et al. Characteristics of Ocular Pain Complaints in Patients With Idiopathic Dry Eye Symptoms. Eye Contact Lens 2016;
• 17 Irvine J, Chong SL, Amirjani N. et al. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve 2004; 30: 182-187 doi:10.1002/mus.20095
• 18 de Godoy CH, Silva PF, de Araujo DS. et al. Evaluation of effect of low-level laser therapy on adolescents with temporomandibular disorder: study protocol for a randomized controlled trial. Trials 2013; 14: 229 doi:10.1186/1745-6215-14-229
• 19 Kam WR, Sullivan DA. Neurotransmitter influence on human meibomian gland epithelial cells. Invest Ophthalmol Vis Sci 2011; 52: 8543-8548 doi:10.1167/iovs.11-8113
• 20 Chung CW, Tigges M, Stone RA. Peptidergic innervation of the primate meibomian gland. Invest Ophthalmol Vis Sci 1996; 37: 238-245
• 21 DeLong MR, Benabid AL. Discovery of high-frequency deep brain stimulation for treatment of Parkinson disease: 2014 Lasker Award. JAMA 2014; 312: 1093-1094 doi:10.1001/jama.2014.11132
• 22 Gupta A, Avci P, Sadasivam M. et al. Shining light on nanotechnology to help repair and regeneration. Biotechnol Adv 2013; 31: 607-631 doi:10.1016/j.biotechadv.2012.08.003
• 23 Passarella S, Karu T. Absorption of monochromatic and narrow band radiation in the visible and near IR by both mitochondrial and non-mitochondrial photoacceptors results in photobiomodulation. J Photochem Photobiol B 2014; 140: 344-358 doi:10.1016/j.jphotobiol.2014.07.021
• 24 Yadav A, Gupta A. Noninvasive red and near-infrared wavelength-induced photobiomodulation: promoting impaired cutaneous wound healing. Photodermatol Photoimmunol Photomed 2017; 33: 4-13 doi:10.1111/phpp.12282
• 25 Mosca RC, Ong AA, Albasha O. et al. Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach. Adv Skin Wound Care 2019; 32: 157-167 doi:10.1097/01.ASW.0000553600.97572.d2
• 26 Gupta PK, Vora GK, Matossian C. et al. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease. Can J Ophthalmol 2016; 51: 249-253 doi:10.1016/j.jcjo.2016.01.005
• 27 Lee WW, Murdock J, Albini TA. et al. Ocular damage secondary to intense pulse light therapy to the face. Ophthalmic Plast Reconstr Surg 2011; 27: 263-265 doi:10.1097/IOP.0b013e31820c6e23
• 28 Jewsbury H, Morgan F. Uveitis and iris photoablation secondary to intense pulsed light therapy. Can J Ophthalmol 2012; 47: e13-e14 doi:10.1016/j.jcjo.2012.01.019