Comparison Between Combined Oral Doxicicline + Intense Pulsed Light Vs Non Combined Strategy In The Treatment Of Refractory Chronic Meibomian Gland Dysfunction. A Prospective Cohort Study.
Published 2024 - 42nd Congress of the ESCRS
Reference: FP15.03 | Type: Free paper | DOI: 10.82333/d8df-4345
Authors: Alfonso Strianese* 1 , Valentino de Ruvo 2 , Alessandra Di Filippo 1 , Silvia Zappa 1 , Paolo Fogagnolo 1
1Ophthalmology,Ospedale San Paolo,Milano,Italy, 2Ophthalmology,Ospedali privati Villa Igea,Forlì,Italy
Purpose
Several treatments are currently available for Meibomian gland disfunction (MGD) but no standard protocols have been sufficiently validated so far. Oral and local antibiotics have been successfully used, as well as intense pulse light (IPL). The literature shows that both antibiotics and IPL reduce lids inflammation and cellular turnover of Meibomian cells and that they can be safely combined, as IPL wavelength doesn’t interact with the photosensitizing tetracyclines. The purpose of this study is therefore to evaluate the efficacy and the safety of a combined IPL + systemic doxycycline treatment in cases of chronic MGD refractory to first line treatment.
Setting
This is a spontaneous , non-randomized, monocentric (ASST- Santi Paolo e Carlo, Università degli studi di Milano, Italy), prospectic, phase IV study.
Methods
A cohort of 100 patients with chronic MGD at baseline (refractory after at least 2 months of first line treatment with meibomian gland expression and artificial tears) was treated with combined treatment with systemic doxycycline (low dose protocol - LDD- 50 mg pro die for 3 months) and IPL or non combined treatment ( Group 1: LDD + IPL , Group 2: LDD, Group 3: IPL). Low tech and High tech parameters (Oculus keratograph) were collected at baseline, 3 and 6 months. OSDI score was administered at each visit. Adverse effect (AE) was also collected
Results
OSDI score significantly improved in all groups, but patients using a combined treatment had more frequently a clinically significant improvement of 7 or more points at OSDI score (p=0.04) . Also TBUT and high-tech significantly improved in all groups. AE related to the doxycycline treatment (list of the main AE) occurred in 7.5%; no AE due to the combination of doxycycline and IPL was reported. No significant differences between two groups have been found in this follow up.
Conclusions
Combined IPL - systemic doxycycline is a safe and effective treatment for refractory MGD leading to a clinically significant improvement of symptoms in 82.7 % of cases. More studies will be necessary to confirm a possible superiority to other current treatments for MGD.