Clinical Results of Intraductal Meibomian Gland Probing Combined with Intense Pulsed Light in Treating Patients with Refractory Obstructive Meibomian Gland Dysfunction: A Randomized Controlled Trial

Abstract

Background: This study aims to optimize the therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their positive effects and reduce their limitations. Methods: This randomized, assessor blind study includes 45 patients (90 eyes) with refractory o-MGD who were divided into 3 groups via allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time), and combined MGP-IPL (group III, MGP first followed by an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and lid margin finding results were assessed at baseline, 3 weeks after final treatment for groups I and III, 3 and 12 weeks after MGP for group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected for all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction, and Kruskal-Wallis tests were used for data analysis. Results: For all 3 groups, all previously mentioned indexes improved significantly following treatment (P＜0.01). MGP-IPL was better than IPL and MGP in terms of post-treatment SPEED, TBUT, meibum grade, and lid telangiectasia (P＜0.05/3). Furthermore, the MGP-IPL was better than IPL in terms of lid tenderness and better than MGP in terms of orifice abnormality (P＜ 0.05/3). Six months later, the SPEED for the MGP-IPL was also significantly lower than other groups (P＜0.05/3). Moreover, no patients in the MGP-IPL group expressed the need to be treated again compared to 35.7% or 20% of patients in the IPL or MGP groups, respectively. Conclusions: Compared with IPL or MGP alone, the combination MGP-IPL produced best results in relieving all signs and symptoms and helping patients attain long-lasting symptom relief. Trial registration: http://clinicaltrials.gov, ChiCTR1900021273 (retrospectively registered February 9, 2019). Funding: This work was supported by the National Natural Science Foundation of China: [grant numbers: 81870624; 81700802] and the Major Science and Technology Projects of Zhejiang Province [grant numbers: 2017C03046].

Therapeutic Instruments Targeting Meibomian Gland Dysfunction

“…There are some differences between both devices such as the treatment schedule. The E [ Eye system is usually applied in three or four sessions, performed on days 1, 15, 45, and 75 [63,70,71], while the M22 system is usually applied in three sessions, separated by 3 or 4 weeks [62,71,72]. The spot size is 15 9 40 mm in E [ Eye and 15 9 35 mm in the M22, and the cooling system is Airflow in the E [ Eye and ChillTip TM Contact in the M22.…”

“…Piyacomn et al [70] (I) observed a higher and faster improvement in the MG function in patients who combined conventional eyelid hygiene and IPL than in those patients who performed hygiene alone. Huang et al [72] (I) compared IPL with intraductal MG probing. They reported that the combination of both methods was more effective than separately in improving symptoms, BUT, meibum grade, and telangiectasias.…”

Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction

“…Four out of the 14 reviewed papers were published in 2019 alone. 13,14,23,30 Additionally, one review article looking at MGP was published this same year. 24 MGP is also mentioned in recent reviews looking at the treatment of MGD, with one published as recently as January, 2020.…”

“…22,23,25,26,36 Four of these five were conducted by the same first author using his past patients' charts. 22,23,25,26 Nine of the included articles described prospective studies, 10,13,14,16,21,29,30,34,38 four of which were RCTs. 13,14,16,21 A majority of the included studies had no control group.…”

Factors Influencing the Effectiveness of Intense Pulsed Light for Meibomian Gland Dysfunction

“…5The CFS scores of each quadrant ranged from 0 to 3 (0: no punctate staining; 1: less than half was stained; 2: more than half was stained; and 3: the whole quadrant was stained). The total score was the sum of the four quadrants of the cornea [20].…”