Adverse Events of Intense Pulsed Light Combined With Meibomian Gland Expression Versus Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction

Abstract

Background and Objective: To analyze the occurrence and causes of adverse events (AEs) in intense pulsed light (IPL) combined with meibomian gland expression (MGX) and MGX treatment alone for meibomian gland dysfunction (MGD). Study Design/Materials and Methods: A retrospective study was conducted on MGD patients treated in Wuhan Aier Hankou Eye Hospital from February 2018 to October 2019 to compare the AEs between IPL-MGX and MGX groups. Relevant AEs that occurred during the treatment and within 1 month after the patients' last treatment were recorded and the causes of the AEs were analyzed. Results: A total of 2,282 patients received IPL-MGX and 1,407 received MGX treatment. No serious AEs occurred in both groups. There were 74 AEs in the IPL-MGX group, with an incidence of 3.24%, including 14 significant AEs (2 cases of epidemic keratoconjunctivitis, 1 recurrent herpes simplex keratitis (HSK), 9 new onsets of floaters, 1 recurrent glaucomatocyclitic crises, and 1 recurrent iridocyclitis). There were 27 AEs in the MGX group with a rate of 1.92%, including 4 significant AEs (2 cases of keratoconjunctivitis epidemic, 2 new cases of floaters). Compared with the IPL-MGX group, the incidence of AEs in the MGX group was lower (P = 0.017). Conclusions: Both IPL-MGX and MGX treatment are safe therapies with low risk for AEs. IPL treatment is not recommended for young children (age 10 or less) as well as patients with anterior uveitis or glaucomatocyclitic crises. The previous history of HSK and eyes with high myopia are advised to exercise caution in IPL treatment. Lasers Surg. Med.

Safety and Feasibility of Low Fluence Intense Pulsed Light for Treating Pediatric Patients with Moderate-to-Severe Blepharitis

“…In a case report of a 10-year-old, IPL of 12.2 J/cm 2 could greatly ease the BKC symptoms [ 16 ]. However, another retrospective study described a transient headache on 3 pediatric BKC patients the night of IPL at 9–13 J/cm 2 [ 17 ]. They speculated that children’s skin was more sensitive to light and that the presence of parasympathetic nerves in the auriculotemporal region might lead to headache symptoms at night.…”

“…In a case report of a 10-year-old, 12.2 J/cm 2 IPL could effectively shorten his BKC course within 17 days [ 16 ]. Different from the common fluence levels of 12–16 J/cm 2 for adults, children were reported to be vulnerable to light therapy [ 17 ]. Thus, we decided to use low fluence IPL on our patients to reduce the possible adverse effects.…”

Complications seen with the use of intense pulsed light sources

“…Patients with a history of anterior uveitis or glaucomatocyclitic crises may be at an increased risk of recurrence with IPL treatment. 23 Protective eyewear must be worn by the clinician, patient, and anyone else in the treatment room. 55 Oftentimes, these staff members are not properly trained, leading to treatment errors and adverse effects.…”

“…Thus, some authors believe that the local transient hyperthermia induced by IPL may activate latent HSV in the trigeminal ganglion. In research conducted by Qiao et al, 23 a patient developed herpes simplex keratitis after IPL treatment of meibomian gland dysfunction. Remington and colleagues 24 described a patient with reactivation of herpes simplex labialis after IPL treatment of facial lentigines.…”

“…IPL can also cause full‐thickness macular holes, as described by Maganti and colleagues 54 in their retrospective study. Patients with a history of anterior uveitis or glaucomatocyclitic crises may be at an increased risk of recurrence with IPL treatment 23 …”