Therapeutic Effect of Intense Pulsed Light Combined with Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction

Objective: To evaluate the short-term therapeutic effect of intense pulsed light combined with meibomian gland expression (IPL/MGX) for the treatment of meibomian gland dysfunction (MGD). Methods: This was a prospective single-arm clinical study that included 55 MGD patients, in which 48 patients (96 eyes) finished the follow-up. IPL/MGX treatment was administered in both eyes, once every 3 weeks for 3 sessions. Testing was performed before treatment and 1 week after treatment and included the ocular surface disease index (OSDI), a questionnaire survey, tear film break-up time, corneal staining, meibomian gland function and imaging, conjunctival bulbar redness, confocal microscope examination of the meibomian gland and mites, etc. A paired t test, Wilcoxon rank sum test and Spearman rank correlation were used for statistical analysis. Results: Ocular surface disease index (t=2.300, P=0.024) meibomian gland expression score and meibum quality score (Z=-3.617, P<0.001; t=2.472, P=0.017), corneal staining score and bulbar redness score (Z=-2.757, P=0.006; t=2.040, P=0.044), inflammatory cell density (t=4.765, P<0.001), and total number of demodex mites in the follicle (t=2.121, P=0.037) were all improved after treatment. The patients with a meibomian gland dropout area of less than 50% had significant improvement of subjective symptoms, ocular surface inflammation and meibomian gland function after treatment. Patients with a meibomian gland dropout area of more than 70% showed no significant improvement before and after treatment. Conclusion: IPL/MGX can significantly improve the subjective symptoms and meibomian gland function of MGD patients with mild atrophy of the meibomian gland, alleviate the inflammation of the ocular surface, reduce the number of demodex mites, and relieve damage onthe ocular surface. Key words: intense pulsed light; meibomian gland expression; meibomian gland dysfunction; in vivo confocal microscopy