One-year outcome of intense pulsed light therapy for refractory meibomian gland dysfunction in patients continuously exposed to topical glaucoma medications: a comparative study

Abstract

Background: To evaluate the one-year effect of intense pulsed light (IPL) for refractory meibomian gland dysfunction (MGD) between patients treated with and without topical hypotensive agents.

Methods: This retrospective study included 21 MGD eyes of 21 glaucoma patients (age, 64.38 ± 13.74 years) and 21 MGD eyes of 21 non-glaucoma patients (age, 63.90 ± 13.50 years). Both arms received IPL therapy with meibomian gland expression (MGX). Propensity score matching ensured baseline comparability. Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film breakup time (TBUT), lid telangiectasia, corneal staining, meibum quality and expressibility were assessed at baseline, 3-, 6-, 9- and 12-months post-treatment.

Results: Both groups showed significant improvement in SPEED score and TBUT at 9 months, but only the non-glaucoma group maintained these improvements at 12 months (P < 0.01). While meibum quality improved in both groups at 12 months, significant improvement in lid telangiectasia and meibum expressibility was observed only in the non-glaucoma group. At 12 months, the non-glaucoma group showed less lid telangiectasia than the glaucoma group (P = 0.009). No other intergroup differences were found in other outcomes. Neither group showed significant improvement in corneal staining throughout the follow-up period.

Conclusions: IPL therapy is effective for treating refractory MGD in both glaucoma and non-glaucoma patients, with significant improvements in dry eye symptoms, tear film stability and meibum quality. However, patients on continuous hypotensive agents showed less improvement in lid telangiectasia at 12 months, suggesting that chronic hypotensive medication use may affect treatment efficacy.

Fig. 1. The treatment protocol for the glaucoma and non-glaucoma group.

IPL intense pulsed light, MGX meibomian gland expression.

Fig. 2. Comparison of one-year outcomes between the glaucoma and non-glaucoma group.

Longitudinal analysis of ocular surface indexes and meibomian gland function are shown. Data are displayed as a mean ± 95% confidence interval for each follow-up time point. Significant changes compared to the baseline level are labelled as the following: P value < 0.05*, <0.01**, <0.001***. SPEED (Standardized Patient Evaluation of Eye Dryness), TBUT (tear film breakup time), CFS (corneal fluorescein staining).