One-year outcome of intense pulsed light therapy for refractory meibomian gland dysfunction in patients continuously exposed to hypotensive agents: a comparative study

Abstract

Background: To compare the one-year effect of intense pulsed light (IPL) for refractory meibomian gland dysfunction (MGD) between patients treated with and without topical hypotensive agents. Methods: This comparative retrospective cohort study included 41 MGD eyes of glaucoma patients (age, 67.59±11.12 years) and 41 MGD eyes of non-glaucoma patients (age, 62.73±15.97 years). Both arms received a course of IPL with meibomian gland (MG) expression (MGX). Baseline characteristics were matched by propensity score test. Standard evaluation including eye dryness (SPEED) questionnaire, tear breakup time (TBUT), lid telangiectasia, corneal fluorescein staining (CFS) score, meibum quality and expressibility were assessed at baseline, 3, 6, 9 and 12 months after treatment. Results: No baseline intergroup heterogeneity was detected after matching. Both groups demonstrated significant improvements in SPEED score (-6.37 vs -3.23), lid telangiectasia (-0.62 vs -0.60), MG expressibility (-0.66 vs -0.93) and meibum quality (-0.83 vs -0.84) at 6 months (all p < 0.01), with a sustainable effect up to 9 months in glaucoma group and 12 months in non-glaucoma group in terms of SPEED score and MG expressibility. Both arms showed significant improvements in TBUT and meibum quality at 12 months (p < 0.01). CFS significantly decreased in the non-glaucoma group at 6 months while there was no significant change of CFS in glaucoma group over the follow-up period. Conclusions: IPL with regular MGX exerts a promising sustainable effect in ameliorating symptoms and signs of MGD patients treated with topical hypotensive agents, but the effect lasts shorter than that in non-glaucoma patients.