Effectiveness and Safety of Combined Application of Three Modes of 2940-nm Erbium:YAG and 1064-nm Neodymium:YAG Lasers in Treatment of Meibomian Gland Dysfunction

Abstract

Purpose: To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD).

Patients and methods: In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded.

Results: Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment.

Conclusion: Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.

Keywords: dry eye; erbium:YAG; meibomian gland dysfunction; meibum; neodymium:YAG.

Figure 1

Treatment areas of steps 1, 2, 3, and 4 of laser treatment. (A) Ten passes with 10 stag pulses using transconjunctival approach in step 1. (B) Three passes with three stag pulses using cutaneous approach on periorbital skin of upper and lower eyelids in step 2. (C) Five passes or until the skin temperature exceeds 40–42°C for 2–3 minutes using cutaneous approach on bulging fat in the lower eyelid in step 3. (D) Three passes using cutaneous approach on periorbital skin of upper and lower eyelids in step 4.

Figure 2

Estimated means with 95% confidence intervals of clinical outcomes at each visit. (A) Estimated mean meibum quality scores; + represents significant difference compared with meibum quality scores at baseline and at 24 weeks. (B) Estimated mean Ocular Surface Disease Index scores. (C) Estimated mean tear film lipid layer thicknesses. (D) Estimated mean tear break-up times (TBUTs) in seconds; + represents significant difference compared with TBUT at baseline and at 16 weeks. (E) Estimated mean Oxford scheme grades. (F) Estimated mean meibography grades.

Figure 3

Meibomian gland morphology in a patient with meibomian gland dysfunction. (A) Meibomian gland morphology before treatment. (B) Meibomian gland morphology at 4 weeks after final treatment. Meibomian gland morphologies were similar in panels (A and B).