Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction

Abstract

Background To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD. Methods In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences. Results There were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014). Conclusions In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.

Hypochlorous Acid Can Be the Novel Option for the Meibomian Gland Dysfunction Dry Eye through Ultrasonic Atomization

“…Meibomian gland dysfunction (MGD) is defined as a team of aberrant signs, acquired or congenital, implicated by dysfunction of the eyelid meibomian glands. MGD leads to affecting tear film function, ocular discomfort, evaporative caused dry eye, or ocular surface problems [ 5 ]. The study of 619 randomly chosen participants from a population-based study in north China; 8.6% were symptomatic MGD while the asymptomatic MGD rate was 21.9% [ 6 ].…”

Candidate Molecular Compounds as Potential Indicators for Meibomian Gland Dysfunction

“…There were significant improvement in the ocular surface staining scores, lid margin findings (lid thickness and telangiectasia), tear breakup time, meibomian gland function, and symptoms ( 100 ). This was accompanied by substantial matrix metalloproteinase-9 immunoassay positivity rate reduction from 4 weeks after treatment ( 100 ). This supports the potential use of matrix metalloproteinase-9 as a monitoring biomarker in MGD.…”

“…Again, Solomon et al discovered that tear film matrix metalloproteinase-9’s activity levels were significantly higher in patients with MGD than in healthy controls ( 69 ). Furthermore Moon et al conducted a retrospective case series study with a total of 48 eyes of 24 patients with a diagnosis of moderate to severe MGD undergoing a single session of lid debris debridement using the BlephEx combined with meibomian gland expression ( 100 ). There were significant improvement in the ocular surface staining scores, lid margin findings (lid thickness and telangiectasia), tear breakup time, meibomian gland function, and symptoms ( 100 ).…”

“…Furthermore Moon et al conducted a retrospective case series study with a total of 48 eyes of 24 patients with a diagnosis of moderate to severe MGD undergoing a single session of lid debris debridement using the BlephEx combined with meibomian gland expression ( 100 ). There were significant improvement in the ocular surface staining scores, lid margin findings (lid thickness and telangiectasia), tear breakup time, meibomian gland function, and symptoms ( 100 ). This was accompanied by substantial matrix metalloproteinase-9 immunoassay positivity rate reduction from 4 weeks after treatment ( 100 ).…”

Comparison of clinical outcomes between intense pulsed light therapy using two different filters in meibomian gland dysfunction: Prospective randomized study

“…Conventional treatments for MGD include antibiotics for lid commensal bacteria 8,9 or co-existing demodex related anterior blepharitis, anti-in ammatory agents [10][11][12][13][14] , and supplementation with omega-3 [15][16][17] . Procedures for MGD management have also been introduced, such as thermal pulsation (electronic heating device, LipiFlow) [18][19][20] and mechanical manipulation of the meibomian gland, such as meibomian gland expression (MGX) and intraductal probing [21][22][23] . Conventional treatments have demonstrated strong therapeutic effects, but only in the short-term 24 .…”