Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India.
GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and.
Cornea. 2022 Sep 1;41(9):1080-1087. doi: 10.1097/ICO.0000000000002954. Epub 2021 Dec 14.
Dry eye disease (DED) is a leading cause of ocular morbidity worldwide. This study evaluates the effects of combined light therapy [intense pulsed light (IPL) and low-level light therapy (LLLT)] on clinical and molecular outcomes in evaporative DED with meibomian gland dysfunction (MGD).
This prospective study evaluated 94 eyes (47 subjects) with chronic MGD treated with combined light therapy. Patients underwent a detailed evaluation of MGD and DED using the Ocular Surface Disease Index, dry eye tests-tear breakup time and Schirmer test, ocular surface staining, meibomian gland expressibility scoring, and meibography. Patients underwent a single session of combined light therapy (IPL + LLLT treatment) using the Eye-light device. All these tests were repeated at 3 and 6 months after treatment. Tear fluid and ocular surface wash samples were collected from a subset of patients before and after treatment for cellular and secreted immune factor profiling by flow cytometry.
Combined light therapy (IPL + LLLT) demonstrated a marked improvement in the clinical metrics studied. Three months after treatment, Ocular Surface Disease Index showed a significant reduction in 95.6% ( P < 0.0001), tear breakup time increased in 72.3% ( P < 0.0001), and meibomian gland expressibility scoring increased in 80.8% ( P < 0.0001) of the eyes. These effects were observed to be sustained during the 6-month follow-up visit. Significant ( P < 0.05) reduction in tear fluid levels of interleukin-1β, interleukin-17F, and MMP9; MMP9/TIMP1 ratio; and ocular surface B-cell proportions was observed.
Combined light therapy shows promising results in patients with chronic MGD and DED, even in recalcitrant cases. Clinical and molecular factor alterations support the improved symptomatology and reduced inflammation.
干眼症（DED）是全球眼部发病率的主要原因。本研究评估了强脉冲光（IPL）和低水平光疗（LLLT）联合治疗睑板腺功能障碍（MGD）的蒸发性 DED 的临床和分子疗效。
本前瞻性研究评估了 94 只眼（47 例）慢性 MGD 患者，这些患者接受了联合光疗。患者接受了详细的 MGD 和 DED 评估，使用眼表疾病指数（OSDI）、泪液破裂时间和泪液分泌试验、眼表面染色、睑板腺分泌能力评分和睑板腺照相。患者接受了 Eye-light 设备的单次联合光疗（IPL+LLLT 治疗）。所有这些测试均在治疗后 3 个月和 6 个月重复进行。从部分患者中采集治疗前后的泪液和眼表冲洗液样本，通过流式细胞术进行细胞和分泌免疫因子分析。
联合光疗（IPL+LLLT）显著改善了研究中的临床指标。治疗后 3 个月，OSDI 显著降低了 95.6%（P<0.0001），泪液破裂时间增加了 72.3%（P<0.0001），睑板腺分泌能力评分增加了 80.8%（P<0.0001）。在 6 个月的随访中观察到这些效果持续存在。泪液中白细胞介素-1β、白细胞介素-17F 和 MMP9；MMP9/TIMP1 比值；以及眼表面 B 细胞比例显著降低（P<0.05）。
联合光疗对慢性 MGD 和 DED 患者，甚至是难治性病例，显示出有前景的疗效。临床和分子因素的改变支持症状的改善和炎症的减轻。
