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

Figures & data

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.

Table 1 Sequences and Parameters of Four-Step Laser Treatment Applied to Upper and/or Lower Eyelids

	Parameter
Step 1: Er:YAG SmoothLiftin^TM	– PS03 handpiece (Spot size 5 mm)
	– Smooth mode (duration 250 msec)
	– Fluence 3.5–5 J/cm2
	– Freque3ncy 2 Hz
Step 2: Er:YAG SmoothLiftin^TM	– PS03 handpiece (Spot size 5 mm)
	– Smooth mode (duration 250 msec)
	– Fluence 3.5–5 J/cm2
	– Frequency 3.3 Hz
Step 3: Nd:YAG PIANO^®	– R34 handpiece (Spot size 15 mm)
	– Sweep mode
	– Fluence 300–500 J/cm2
	– Pulse width 16 sec
Step 4: Er:YAG SupErficial^TM	– PS03 handpiece (Spot size 7 mm)
	– Micro-short pulse mode (duration 100 microsec)
	– Fluence 2 J/cm2
	– Frequency 10 Hz

Abbreviations: Er, erbium; YAG, yttrium aluminium garnet; Nd, Neodymium.

Table 2 Clinical Characteristics at Baseline and at 16-Week and 24-Week Follow-Ups

	Baseline	16-Week Follow-Up	24-Week Follow-Up
	Mean [95% CI]	Mean [95% CI]	Mean [95% CI]
OSDI scores	25.41 [16.60, 34.22]	22.18 [13.37, 30.99]	31.35 [22.29, 40.42]
TFLLT	61.81 [48.87, 74.76]	63.5 [50.55, 76.45]	69.62 [56.36, 82.88]
TBUT(s)	3.75 [3.04, 4.46]	3.48 [2.77, 4.19]	2.09 [1.37, 2.82]
Oxford scheme grade	2.50 [1.51, 3.49]	1.94 [0.95, 2.93]	2.68 [1.67, 3.69]
Meibography grade	1.50 [1.16, 1.84]	1.38 [1.04, 1.71]	1.26 [0.92, 1.61]
Meibum quality scores	11.81 [9.57, 14.06]	7.75 [5.50, 10.00]	12.53 [10.21, 14.85]

Abbreviations: CI, confidence interval; OSDI, Ocular Surface Disease Index; TFLLT, tear film lipid layer thickness; TBUT, tear break-up time; s, seconds.

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).