Efficacy of intense pulsed light combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction in the cataract perioperative period

Objective

To investigate the efficacy of intense pulsed light (IPL) combined with meibomian gland expression for moderate to severe dry eye associated with meibomian gland dysfunction (MGD) in cataract patients during the perioperative period.

Methods

A non-randomized controlled study was conducted.Forty patients (40 eyes) with moderate to severe dry eye associated with MGD who planned to undergo binocular cataract extraction combined with intraocular lens (IOL) implantation at Beijing Tongren Hospital, Capital Medical University were enrolled from October 2020 to December 2021.One eye of each patient was randomly included using Excel RAND function.All patients received artificial tears regularly to treat dry eye symptoms, and meibomian gland expression was performed as needed.Patients were divided into a treatment group (20 patients, 20 eyes) and a control group (20 patients, 20 eyes) according to whether they wished to receive IPL therapy.The treatment group received IPL therapy 3 times before surgery, with a 2-week interval between each therapy, and phacoemulsification combined with IOL implantation at least 2 weeks after the last treatment.The two groups were evaluated at baseline, 1 day before surgery (i.e.2 weeks after the last IPL treatment for the treatment group), 1 week after surgery and 1 month after surgery.Outcome measures included Ocular Surface Disease Index (OSDI), corneal fluorescence staining, Schirmer Ⅰ test (SⅠt), tear break-up time (TBUT), meniscus height, the number of eyes with different scores of meibomian gland atrophy and the number of eyes with different scores of meibomian gland excretion capacity.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2017-063). Written informed consent was obtained from each subject.

Results

Baseline, 1-day preoperative, 1-week postoperative, 1-month postoperative OSDI scores were (47.83±10.17), (47.50±10.75), (66.08±12.68), (67.92±16.51) points in control group, and (62.50±12.04), (20.05±4.65), (24.75±5.98), (12.65±3.01) points in treatment group, respectively.There were significant differences in the overall comparison of OSDI scores between the two groups at different time points (F_group=119.351, P<0.01; F_time=86.219, P<0.01). The 1-day preoperative, 1-week postoperative and 1-month postoperative OSDI scores were lower and the baseline OSDI score was higher in the treatment group than in the control group, showing statistically significant differences (all at P<0.05). In the treatment group, the OSDI score 1 day before surgery was significantly lower than baseline, and 1 week after surgery was significantly higher than 1 day before surgery, but significantly lower than baseline, and decreased significantly again at 1 month after surgery (all at P<0.05). In the control group, the OSDI score was significantly higher at 1 week and 1 month after surgery than at 1 day before surgery and at baseline (all at P<0.05). The number of eyes with corneal fluorescence staining 1 day before surgery, 1 week after surgery and 1 month after surgery was significantly lower in the treatment group than in the control group (all at P<0.01). The SⅠt values 1 day before surgery, 1 week after surgery and 1 month after surgery were higher in the treatment group than in the control group but significantly higher than the baseline value, and the differences were statistically significant (all at P<0.05). The SⅠt value 1 month after surgery was significantly higher in the treatment group than before surgery and 1 week after surgery (both at P<0.05). The TBUT values 1 day before surgery, 1 week after surgery and 1 month after surgery were greater in the treatment group than in the control group and at baseline, and the 1-month postoperative TBUT of the treatment group was significantly higher than the 1-week postoperative TBUT (all at P<0.05). Meniscus height 1 day before surgery, 1 week after surgery and 1 month after surgery was greater in the treatment group than in the control group and at baseline, and the differences were statistically significant (all at P<0.05). There was no statistically significant difference in the number of eyes with different scores of meibomian gland atrophy between the two groups at different time points (all at Z=-0.628, P=0.530). There was no statistically significant difference in the number of eyes with different scores of meibomian gland excretion capacity between the control and treatment groups at baseline, 1 day before surgery, 1 week after surgery and 1 month after surgery (all at P>0.05).

Conclusions

IPL is effective for treating dry eye associated with MGD in cataract patients during the perioperative period, and it can effectively improve dry eye symptoms and signs in patients after cataract surgery.

Intense pulsed light therapy; Dry eye syndrome; Meibomian gland dysfunction; Cataract surgery; Efficacy