Arita Reiko, Mizoguchi Takanori, Fukuoka Shima, Morishige Naoyuki
Department of Ophthalmology, Itoh Clinic, Saitama, Japan.
Lid and Meibomian Gland Working Group (LIME), Tokyo, Japan.
Cornea. 2018 Dec;37(12):1566-1571. doi: 10.1097/ICO.0000000000001687.
To evaluate the efficacy of intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) for refractory meibomian gland dysfunction (MGD) in a prospective study conducted at 3 sites in Japan.
Patients with refractory obstructive MGD were enrolled and underwent 4 to 8 IPL-MGX treatment sessions at 3-week intervals. Clinical assessment included the Standard Patient Evaluation of Eye Dryness questionnaire; noninvasive breakup time of the tear film and interferometric fringe pattern as determined by tear interferometry; lid margin abnormalities, fluorescein breakup time of the tear film, corneal and conjunctival fluorescein staining (CFS), and meibum grade as evaluated with a slit-lamp microscope; meibomian gland morphology (meiboscore); and tear production as measured by the Schirmer test without anesthesia.
Sixty-two eyes of 31 patients (17 women, 14 men; mean age ± SD, 47.6 ± 16.8 years) were enrolled. The Standard Patient Evaluation of Eye Dryness score (P < 0.001), noninvasive breakup time (P < 0.001), and interferometric fringe pattern (P < 0.001) were significantly improved after therapy, with 74% of eyes showing a change in the interferometric fringe pattern from 1 characteristic of lipid deficiency to the normal condition. Meibum grade, lid margin abnormality scores, fluorescein breakup time, and CFS were also significantly improved (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively) after treatment, whereas the meiboscore and Schirmer test value remained unchanged.
IPL-MGX ameliorated symptoms and improved the condition of the tear film in patients with refractory MGD and is therefore a promising treatment option for this disorder.
在日本的3个地点进行的一项前瞻性研究中，评估强脉冲光（IPL）疗法联合睑板腺按摩（MGX）治疗难治性睑板腺功能障碍（MGD）的疗效。
纳入难治性阻塞性MGD患者，每3周接受4至8次IPL-MGX治疗。临床评估包括干眼标准患者评估问卷；通过泪液干涉测量法测定的泪膜非侵入性破裂时间和干涉条纹图案；用裂隙灯显微镜评估的睑缘异常、泪膜荧光素破裂时间、角膜和结膜荧光素染色（CFS）以及睑脂等级；睑板腺形态（睑板腺评分）；以及无麻醉下通过Schirmer试验测量的泪液分泌量。
纳入31例患者的62只眼（17例女性，14例男性；平均年龄±标准差，47.6±16.8岁）。治疗后干眼标准患者评估评分（P<0.001）、非侵入性破裂时间（P<0.001）和干涉条纹图案（P<0.001）显著改善，74%的眼干涉条纹图案从脂质缺乏特征转变为正常状态。治疗后睑脂等级、睑缘异常评分、荧光素破裂时间和CFS也显著改善（分别为P<0.001、P<0.001、P<0.001和P=0.002），而睑板腺评分和Schirmer试验值保持不变。
IPL-MGX改善了难治性MGD患者的症状并改善了泪膜状况，因此是这种疾病一种有前景的治疗选择。
