Purpose: To evaluate the efficacy of additional thermal pulsatile system compared to standard lid hygiene alone in meibomian gland dysfunction (MGD) patients who are using long-term anti-glaucoma medications. Patients and Methods: Well-controlled glaucoma patients who used anti-glaucoma medications for at least 1 year and had MGD were enrolled and randomized between a study group who received thermal pulsatile system (Lipiflow ®) treatment and standard lid hygiene, and a control group who received standard lid hygiene alone. The primary outcome was meibomian gland expression score, and the secondary outcomes were the Ocular Surface Disease Index (OSDI) score, Schirmer test score, tear break-up time (TBUT), corneal staining score, lipid layer thickness (LLT), and meibography score. All the outcomes were re-evaluated at 1 week, then at 1, 3, and 6 months after treatment. Results: Of 60 participants who underwent randomization, 48 completed the study. At the 6-month mark, this study could not demonstrate any significant difference between groups in both primary and secondary outcomes. However, there was significant improvement from baseline in both groups of the following outcomes: meibomian gland expression score, OSDI score, LLT, and meibography score. No serious adverse event was found in this study. Conclusion: An additional single thermal pulsatile system treatment with standard lid hygiene significantly improved meibomian gland assessment score and subjective symptoms at 6 months. Any difference between additional thermal pulsatile system treatment and lid hygiene alone was not found in this study. The results may suggest more chronic MGD and more damaged meibomian gland induced by long-term anti-glaucoma medications.

Purpose: To compare the efficacy and safety of topical bevacizumab eye drop versus intra-meibomian gland injection of bevacizumab when used with the standard lid hygiene in meibomian gland dysfunction (MGD) patients. Methods: 60 eyes of 30 MGD patients with lid margin telangiectasia were randomized to receive 0.05% bevacizumab eye drop or single 2.5% intra-meibomian gland bevacizumab injection plus standard lid hygiene. The primary outcomes were telangiectasia grading and the computerized lid margin neovascularized area (LMNA). The secondary outcomes were the ocular surface disease index (OSDI) score, corneal staining, meibomian gland quality, meiboscore, conjunctival redness, fluorescein break up time (FBUT), noninvasive tear breakup time (NIBUT), lipid layer thickness (LLT), compliance of treatments, and adverse events (AE). All the parameters were re-evaluated before and until 3 months after treatment. Results: A significant improvement in telangiectasia grading and LMNA, primary outcomes, were observed in injection group at month 3 (p<0.05) but LMNA was not apparent in the eye drop group. In the injection group, there were significant improvements in corneal staining, meiboscore, and FBUT compared with the eye drop group (p<0.05). Both groups showed significant improvements in OSDI score, corneal staining, MG quality, meiboscore, and conjunctival redness compared with pre-treatment. (p<0.05). Conclusions: Both routes of intra-MG injection and eye drop bevacizumab administrations were safe and effective in reducing lid margin telangiectasia and signs and symptoms of MGD. Therefore, both routes of administration could be an alternative or adjunctive treatment with the standard lid hygiene for MGD patients.

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AimsThis study aimed to evaluate the efficacy and safety of bevacizumab eye drops compared with those of an intra-meibomian gland (MG) injection of bevacizumab when performed in conjunction with standard lid hygiene in patients with meibomian gland dysfunction (MGD)-associated posterior blepharitis.MethodsThis prospective, open-label, observer-blinded randomized controlled trial included 60 eyes of 30 patients with MGD-associated posterior blepharitis who exhibited lid margin telangiectasia, treated at the Chula Refractive Surgery Center of King Chulalongkorn Memorial Hospital. Patients were randomized to receive lid hygiene plus 0.05% bevacizumab eye drops or a single intra-MG injection of 2.5% bevacizumab. All patients were instructed to perform routine lid hygiene care as demonstrated in an instructional video. Primary outcomes included telangiectasia grading and the lid margin neovascularized area (LMNA). Secondary outcomes included the Ocular Surface Disease Index (OSDI) score, corneal staining, meibum quality, meiboscore, conjunctival redness, fluorescein break-up time (FBUT), lipid layer thickness, treatment compliance, and adverse events. All parameters were evaluated before and 3 months after treatment.ResultsAfter treatment, there were no significant differences in telangiectasia grade and LMNA between groups (mean difference, −0.14, 95% CI −0.42 to 0.15, p = 0.338, −0.1, 95% CI −1.1 to 0.8, p = 0.761, respectively); however, the injection group exhibited significant improvements in both telangiectasia grade and LMNA, while, in the eye drop group, only telangiectasia grade showed a significant improvement relative to baseline. The injection group also exhibited significant improvements in corneal staining (mean difference, −0.78, 95% CI −1.29 to −0.27, p = 0.003), meiboscores (mean difference, −0.37, 95% CI −0.52 to −0.21, p &lt;0.001), and FBUT (mean difference, 1.25, 95% CI 0.21–2.29, p = 0.019) compared to the eye drop group. OSDI scores, corneal staining, meibum quality, meiboscores, and conjunctival redness significantly improved relative to baseline in both groups. No local and systemic adverse event was observed at month 3 in both groups.ConclusionWhen performed with regular lid hygiene, intra-MG injection and topical application of bevacizumab are safe and effective for improving lid margin telangiectasia and the signs and symptoms of MGD-associated posterior blepharitis. This therapy may represent an alternative or adjunctive treatment for patients with MGD-associated posterior blepharitis.