Intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) may be a promising treatment for patients with meibomian gland dysfunction (MGD), a new study in Cornea suggests.

Japanese researchers enrolled patients with refractory obstructive MGD in this prospective study that included 62 eyes of 31 patients. The patients underwent four-to-eight IPL treatments along with meibomian gland expression at three-week intervals. The number of treatments was dependent on the meibum grade.

The patients were given a clinical assessment that included: a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire; noninvasive breakup time of the tear film and interferometric fringe pattern by tear interferometry; lid margin abnormality testing; fluorescein breakup time of the tear film, corneal and conjunctival fluorescein staining (CFS) and meibum grade slit-lamp evaluation; meibomian gland morphology (meiboscore); and Schirmer testing.

Researchers found the SPEED score was significantly reduced at four weeks after the final IPL-MGX treatment session compared with baseline, with 81%of the treated eyes showing improved ocular symptoms. Additionally, the study reported the noninvasive breakup time and fluorescein breakup time were significantly prolonged at four weeks after the final treatment. Investigators reported 70% of treated eyes showed improvement in fluorescein breakup time, and there was an 84% improvement in noninvasive breakup time.

Also of note: tear interferometric fringe grading significantly improved at four weeks after the final treatment with 74% of treated eyes showing a change in the interferometric fringe pattern from crystal-like, indicating a lipid deficiency, to pearl-like, exhibiting a normal condition. Also, meibum grade, lid margin abnormality scores

and CFS were significantly decreased at four weeks after the final treatment. However, the meiboscore and Schirmer test value were not significantly improved after treatment.

This is the first prospective and multicenter study to show improvement in the subjective symptoms and objective signs of refractory severe MGD after a series of IPL treatments combined with MGX, investigators noted.

“In conclusion, our results suggest that IPL-MGX therapy is effective for patients with refractory MGD whose severe disease is difficult to manage with other conventional therapies. IPL-MGX thus has the potential to help many patients with MGD and is a promising modality for refractory MGD in particular,” researchers said.

Arita R, Mizoguchi T, Fukuoka S, et al. Multicenter study of intense pulsed light therapy for patients with refractory meibomian gland dysfunction. Cornea. Dec;37(12):1566-71.