Chengdu University of Traditional Chinese Medicine, Sichuan Province, Chengdu, 610000, China.
Department of Ophthalmology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu Province, 210000, China.
Graefes Arch Clin Exp Ophthalmol. 2021 Jan;259(1):1-10. doi: 10.1007/s00417-020-04834-1. Epub 2020 Jul 28.
Intense pulsed light therapy (IPL) is a new method being used to treat meibomian gland dysfunction (MGD) globally. With an increasing number of studies being published, it is necessary to consider additional factors related to treatment. This review aims to investigate the efficacy and safety of IPL for the treatment of MGD.
The PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and SinoMed databases were searched through February 24, 2020. Randomized clinical trials and cohort studies comparing IPL+ meibomian gland expression (MGX) or IPL alone with control groups were included. The weighted mean difference (WMD) was calculated to analyze the Ocular Surface Disease Index (OSDI) score and Standard Patient Evaluation of Eye Dryness (SPEED) score, and the standard mean difference (SMD) was calculated to analyze the tear breakup time (TBUT). Heterogeneity was quantified by the I statistic ranging from 0 to 100%, and a random effects model was used in this meta-analysis. All analyses were performed by RevMan 5.3. All p values were calculated by the t test, and p values were regarded as statistically significant at p < 0.05. The Cochrane Collaboration's tool for assessing risk of bias was used to identify and evaluate bias in the literature.
Nine studies with a total of 539 patients were included. Eight studies examined TBUT, six examined OSDI scores, and four examined SPEED scores. IPL combined with MGX showed superiority regarding the TBUT (SMD 2.33, 95% CI 1.04-3.61), and OSDI scores (WMD 11.93, 95% CI - 17.10 to - 6.77), with high heterogeneity. The SPEED scores were not significantly different.
IPL combined with MGX may be an effective and safe treatment for MGD, but it cannot improve all symptoms. IPL alone is not superior to MGX. The efficacy is also affected by the number and average frequency of treatments. The efficacy of IPL may decrease within 6 months after the last treatment, so it should be considered a long-term adjuvant therapy combined with MGX. When patients receive 3 or 4 treatments (once every 3-4 weeks), a return visit at 6 months after the last treatment is required.
强脉冲光疗法（IPL）是一种在全球范围内用于治疗睑板腺功能障碍（MGD）的新方法。随着越来越多的研究发表，有必要考虑与治疗相关的其他因素。本综述旨在探讨 IPL 治疗 MGD 的疗效和安全性。
通过 2020 年 2 月 24 日检索 PubMed、EMBASE、Web of Science、Cochrane 图书馆、Google Scholar、中国国家知识基础设施（CNKI）、万方、维普和中国生物医学文献数据库，纳入比较 IPL+睑板腺挤压（MGX）或 IPL 单独治疗与对照组的随机临床试验和队列研究。采用加权均数差（WMD）分析眼表疾病指数（OSDI）评分和标准患者眼干燥评估（SPEED）评分，采用标准均数差（SMD）分析泪膜破裂时间（TBUT）。采用 I ² 统计量量化异质性，范围为 0 至 100%，本荟萃分析采用随机效应模型。所有分析均采用 RevMan 5.3 进行。所有 p 值均通过 t 检验计算，p 值＜0.05 时认为差异有统计学意义。采用 Cochrane 协作网偏倚风险评估工具识别和评估文献中的偏倚。
纳入 9 项研究，共 539 例患者。8 项研究检测 TBUT，6 项研究检测 OSDI 评分，4 项研究检测 SPEED 评分。IPL 联合 MGX 在 TBUT（SMD 2.33，95%CI 1.04-3.61）和 OSDI 评分（WMD 11.93，95%CI -17.10 至 -6.77）方面具有优势，但存在高度异质性。SPEED 评分无显著差异。
IPL 联合 MGX 可能是治疗 MGD 的一种有效且安全的方法，但不能改善所有症状。单独 IPL 并不优于 MGX。疗效还受到治疗次数和平均频率的影响。治疗结束后 6 个月内 IPL 疗效可能下降，因此应将其视为联合 MGX 的长期辅助治疗。当患者接受 3 或 4 次治疗（每 3-4 周 1 次）时，需要在最后 1 次治疗后 6 个月进行随访。
