Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2022 Dec;36(6):527-542. doi: 10.3341/kjo.2022.0068. Epub 2022 Oct 25.
To evaluate the effect of the intense pulsed light (IPL) and meibomian gland (MG) expression (MGX) combination therapy according to the total numbers of sessions in the meibomian gland dysfunction (MGD).
Ninety patients with MGD were included. Patients had maximal five sessions of IPL (Aqua Cel, Jeisys Medical) and MGX combination therapy at 2-week intervals. The ocular surface disease index (OSDI) questionnaire score, MG profile grades, tear matrix metalloproteinase-9 (MMP-9), tear break-up time (BUT), tear osmolarity, tear secretion, and corneal erosions were evaluated.
The number of patients who had a total of one to five sessions (1S to 5S) was 10, 25, 17, 20, and 18, respectively. The time-serial decrease of OSDI scores was significant in patients who had three or more sessions (3S, p = 0.002; 4S, p < 0.001; 5S, p < 0.001). The MG expressibility grade decreased with two or more sessions (2S-5S, p < 0.001), but the meibum quality significantly improved with all sessions (1S, p = 0.012; 2S, p = 0.024; 3S, p = 0.015; 4S, p < 0.001; 5S, p < 0.001). Although tear BUT increased even in patients with one session (1S, p = 0.040; 3S, p = 0.005; 4S, p = 0.006; 5S, p = 0.021), tear MMP-9, osmolarity, Schirmer I, and corneal erosions were not improved in every number of sessions. The female sex was the sole contributor to the final symptomatic improvement (p = 0.042), and the MGD stages were not related to the final OSDI decrease.
The OSDI score, MGD grades, and BUT were improved after the IPL and MGX combination therapy in MGD patients. Unlike MGD grades and tear film instability might be improved just after a few sessions, the overall subjective relief was accomplished in three or more sessions.
根据睑板腺功能障碍（MGD）的总治疗次数评估强脉冲光（IPL）和睑板腺表达（MGX）联合治疗的效果。
纳入 90 例 MGD 患者，每 2 周接受 5 次 IPL（Aqua Cel、Jeisys Medical）和 MGX 联合治疗。评估眼表疾病指数（OSDI）问卷评分、MG 形态分级、泪液基质金属蛋白酶-9（MMP-9）、泪膜破裂时间（BUT）、泪液渗透压、泪液分泌和角膜上皮缺损。
共有 10、25、17、20 和 18 例患者接受了总共 1 至 5 次（1S 至 5S）治疗。接受 3 次或更多次治疗的患者 OSDI 评分呈时间序列下降（3S，p = 0.002；4S，p < 0.001；5S，p < 0.001）。MG 表达可评估性分级随 2 次或更多次治疗而降低（2S-5S，p < 0.001），但所有治疗次数的睑脂质量均显著改善（1S，p = 0.012；2S，p = 0.024；3S，p = 0.015；4S，p < 0.001；5S，p < 0.001）。尽管单次治疗（1S，p = 0.040；3S，p = 0.005；4S，p = 0.006；5S，p = 0.021）后 BUT 也有所增加，但泪液 MMP-9、渗透压、Schirmer I 和角膜上皮缺损在每次治疗中均未得到改善。女性是最终症状改善的唯一贡献者（p = 0.042），MGD 分期与最终 OSDI 降低无关。
IPL 和 MGX 联合治疗 MGD 患者后，OSDI 评分、MGD 分级和 BUT 均得到改善。与 MGD 分级和泪膜不稳定不同，仅经过几次治疗可能会得到改善，而三次或更多次治疗才能达到整体的主观缓解。
