EFFECT OF TREATMENT WITH TOPICAL AZITHROMYCIN OR ORAL DOXYCYCLINE ON TEAR FILM THICKNESS IN PATIENTS WITH MEIBOMIAN GLAND DYSFUNCTION – A RANDOMIZED, ACTIVE CONTROLLED, PARALLEL GROUP STUDY

Published 2022 - 26th ESCRS Winter Meeting

Reference: FP89 | Type: Abstracts | DOI: 10.82333/r684-0f67

Authors: Andreas Schlatter* ¹ , Nikolaus Hommer ² , Martin Kallab ² , Hannes Stegmann ³ , Kristina Zeller ⁴ , Stefan Palkovits ⁴ , Oliver Findl ⁴ , René Marcel Werkmeister ³ , Leopold Schmetterer ⁵ , Gerhard Garhöfer ² , Doreen Schmidl ²

¹Department of Clinical Pharmacology,Medical University of Vienna,Vienna,Austria;Vienna Institute for Research in Ocular Sugery, Department of Ophthalmology,Hanusch Hospital,Vienna,Austria, ²Department of Clinical Pharmacology,Medical University of Vienna,Vienna,Austria, ³Center for Medical Physics and Biomedical Engineering,Medical University of Vienna,Vienna,Austria;Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers,Medical University of Vienna,Vienna,Austria, ⁴Vienna Institute for Research in Ocular Sugery, Department of Ophthalmology,Hanusch Hospital,Vienna,Austria, ⁵Department of Clinical Pharmacology,Medical University of Vienna,Vienna,Austria;Center for Medical Physics and Biomedical Engineering,Medical University of Vienna,Vienna,Austria;Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers,Medical University of Vienna,Vienna,Austria;Singapore Eye Research Institute,Singapore National Eye Centre,Singapore,Singapore;Nanyang Technological University,Nanyang Technological University,Singapore,Singapore;Ophthalmology and Visual Sciences Academic Clinical Program,Duke-NUS Medical School,Singapore,Singapore;SERI-NTU Advanced Ocular Engineering (STANCE),Nanyang Technological University,Singapore,Singapore;Institute of Molecular and Clinical Ophthalmology,Institute of Molecular and Clinical Ophthalmology,Basel,Switzerland

Purpose

Aim of this randomized, active controlled, parallel group study was to compare the effect of topical azithromycin and oral doxycycline on tear film thickness (TFT) and signs and symptoms of ocular surface disease (OSD) in patients with meibomian gland dysfunction (MGD).

Setting

All study-related measures as well as data collection were performed at the Department of Clinical Pharmacology and at the Centre for Medical Physics and Biomedical Engineering of the Medical University of Vienna.

Methods

Patients with MGD were randomized to either receive topical azithromycin (Azyter^® 15 mg/g, one drop twice daily in both eyes for two days, then once daily for 26 days) or oral doxycycline (Doxycycline Genericon 100 mg, twice daily for six weeks). In total, four study visits at intervals of two weeks were scheduled. Main outcome of the study was change in TFT as measured with ultra-high resolution optical coherence tomography (UHR-OCT). Ocular Surface Disease Index (OSDI), composite sign score for OSD, lipid layer thickness (LLT), tear film osmolarity, conjunctival staining as assessed with Lissamine green and Schirmer Test I served as secondary outcomes.

Results

Twenty patients were included in the final analysis. TFT significantly increased in both groups (p = 0.028 vs. baseline) with no difference between the two groups (p = 0.096 between groups). Additionally, OSDI score and composite signs of OSD significantly decreased in both groups (p = 0.023 for OSDI and p = 0.016 for OSD signs vs. baseline). There were no significant changes in LLT, tear film osmolarity, conjunctival staining or Schirmer test I. Systemic adverse events (AEs) were more frequent in the doxycycline group, while in the azithromycin group mainly local AEs occurred.

Conclusion

Treatment with both topical azithromycin and systemic doxycycline improved signs and symptoms of OSD in patients with MGD. There was no difference between the two treatment groups. Topical application of azithromycin seems to be an alternative to systemic doxycycline, as systemic side effects are less common.