Therapeutic effect of intense pulsed light with optimal pulse technology on meibomian gland dysfunction with and without ocular Demodex infestation

Abstract

Background: To evaluate the therapeutic effect of intense pulsed light (IPL) therapy with optimal pulse technology (OPT) on meibomian gland dysfunction (MGD) with and without ocular Demodex infestation. Methods: This prospective study included 150 patients with MGD who were divided into Demodex-infested (DI) and non-infested (control) groups according to Demodex counts determined by epilating eyelashes to evaluate. Each patient underwent three OPT treatment sessions at 3-week intervals. Best corrected visual acuity (BCVA), intraocular pressure (IOP), Demodex counts, Ocular Surface Disease Index (OSDI) score, conjunctival congestion, tear meniscus height (TMH), tear breakup time (TBUT), Schirmer I test (SIT), corneal and conjunctival fluorescein staining scores, meibomian gland (MG) macrostructure, lid margin abnormality, MG expressibility, and meibum quality were assessed before the first treatment as baseline and at 1, 2, and 3 months (M1, M2 and M3, respectively) after treatment.Results: The incidence of Demodex infestation was 59.15% (84/142) at baseline and the final Demodex eradication rate at M3 was 83.3% (70/84). Corneal staining and conjunctival congestion showed slower improvement in the DI group than in the control group at M1 and M2 (P<0.05), but was significantly improved at M3 than that at with baseline (P<0.01). Both the groups showed significant improvement in OSDI, conjunctival congestion, TBUT, corneal and conjunctival staining, MG dropout, lid margin abnormality, MG expressibility, and meibum quality at M3 (P<0.05). No differences were observed for BCVA, IOP, SIT, and TMH before and after treatment in both the groups (P>0.05).Conclusions: This new-generation IPL with OPT treatment results in greater improvement in MG expressibility and meibum quality in MGD patients with Demodex infestation than in those without, but not for corneal staining.

Therapeutic Effect of Intense Pulsed Light in Patients with Sjögren’s Syndrome Related Dry Eye

“…Some of the measured parameters have improved through follow-up in both study groups, but the IPL-MGX groups showed greater improvement than the control group in the OSDI score, NBUT (weeks 12 and 15), CFS (weeks 12 and 15), eyelid margin abnormalities, MGX (weeks 9 and 12), and meibum quality. These findings were consistent with our earlier studies showing the effectiveness of IPL as a treatment for MGD and ocular demodicosis [ 14 , 22 ].…”

“…The Snellen BCVA score was included for safety assessment when we designed this experiment. Unexpectedly, the vision of participants treated with IPL-MGX showed a remarkable improvement that persisted through all three follow-up assessments (all p < 0.001), unlike the patients with non-SS DE in our previous IPL experiment [ 14 ]. Although the differences between the treatment and control groups did not reach the significance level, we were satisfied with the significant improvement in visual acuity in some patients, including those in which topical cyclosporine or autologous serum treatment had failed.…”

“…The clinical parameters evaluated were similar to our previous study [14]. The 12-item OSDI questionnaire assessed the ocular surface-related symptoms and their severity and frequency.…”

“…Intense pulsed light (IPL) has been widely used to treat evaporative DE, mostly secondary to MGD [ 12 , 13 ] or ocular demodicosis [ 14 ]. As far as we know, only one retrospective study has reported using IPL to treat seven patients with SS-DE [ 15 ].…”

Advances in Dry Eye Disease Examination Techniques

“…When Demodex mites infect the margin of the eyelid, the skin of the margin of the eyelid, the hair follicles and glands of the eyelid, and the meibomian glands will accumulate mites, and symptoms related to dry eye will occur ( 138 ). In addition, a typical clinical manifestation of Demodex blepharitis is cylindrical dandruff at the root of the eyelash, and this is considered pathognomonic for Demodex blepharitis ( 139 ). To detect Demodex mites, an optical microscope is used to examine eyelashes with typical cylindrical dandruff characteristics.…”