Effectivity Of Intense Pulsed Light Therapy Combined With Meibomian Gland Expression For Patients With Dry Eye Disease Secondary To Meibomian Gland Dysfunction: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease (DED), a prevalent ocular surface disorder. Intense pulsed light (IPL) combined with meibomian gland expression (MGX) has emerged as a therapeutic option, however its comparative effectiveness remains uncertain. This study aimed to evaluate the effectiveness of combined IPL therapy and MGX in the management of DED secondary to MGD.

This study was conducted as a systematic review and meta-analysis of randomized controlled trials performed in ophthalmology clinical settings. Literature searches were performed in Cochrane, PubMed, ScienceDirect, EBSCO, and ProQuest databases.

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using Cochrane, PubMed, ScienceDirect, EBSCO, and ProQuest. Eligible studies compared IPL combined with MGX versus control interventions in patients with DED secondary to MGD. Risk of bias was assessed using standardized criteria, and certainty of evidence was evaluated. Outcomes were pooled using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was quantified using the I² statistic.

Nine RCTs involving 581 patients (1,162 eyes) met inclusion criteria. Compared with control treatments, IPL combined with MGX significantly improved tear break-up time (TBUT) (SMD 0.68; 95% CI 0.27–1.10; I² = 87%) and meibomian gland yielding secretion score (MGYSS) (SMD 0.90; 95% CI 0.12–1.68; I² = 86%). Corneal fluorescein staining (CFS) showed no statistically significant difference (SMD 0.33; 95% CI −0.39 to 1.05). Symptom scores demonstrated variable results, SPEED showed a non-significant trend toward improvement (SMD 0.65; 95% CI −0.07 to 1.36), while OSDI revealed no significant difference (SMD 0.00; 95% CI −0.43 to 0.43; I² = 36%). Substantial heterogeneity was observed across several outcomes.

IPL combined with MGX improves objective clinical parameters of tear film stability and meibomian gland function in DED secondary to MGD. However, improvements in patient reported symptoms are inconsistent and heterogeneity among studies is considerable. The therapy appears safe, with predominantly mild and transient adverse events.