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

BackgroundThis 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.MethodsThis 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.ResultsFor 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.ConclusionsCompared 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 registrationhttp://clinicaltrials.gov, ChiCTR1900021273 (retrospectively registered February 9, 2019).

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 × 40 mm in E > Eye and 15 × 35 mm in the M22, and the cooling system is Airflow in the E > Eye and ChillTip™ 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.…”

Outcomes of serial sessions of Activa mask combined with intense pulsed light therapy in patients with Meibomian gland dysfunction

“…IPL can be used alone or as a helpful supplementary therapy combined with other in-office procedures, especially in recalcitrant MGD cases. Various papers reported positive results obtained by the combined use of IPL with meibomian gland expression [ 26 ], meibomian gland probing [ 29 ], and low-level light therapy [ 30 ].…”

Meibography guided intraductal meibomian gland probing using real-time infrared video feed

“…9 The approach to using gland probing as first intervention for MGD not responding to conventional therapy of warm compresses, massage and artificial tears was evaluated in a recently published randomised controlled trial. 28 Researchers found best clinical results with statistically significant improvement in standardised patient evaluation of eye dryness scores, tear break up time, meibum grade and lid telangiectasia using probing as initial therapy to physically release fixed obstructions and restore ductal integrity followed by subsequent IPL to 'inhibit telangiectasia' as compared with probing or IPL alone. Gland probing alone was found to provide statistically significant improvement in lid tenderness when compared with intense pulsed light (IPL) alone (p<0.001).…”