Intense Pulsed Light Therapy In The Treatment Of Meibomian Gland Dysfunction: Current Perspectives

Figures & data

Table 1 Retrospective Studies On IPL For DED Therapy

Study (Year)	Design	Patients (n)	IPL Device	Frequency (Weeks)	IPL Sessions (n)	IPL Energy (J/cm^2)	Adverse Events	Results
Gupta et al (2016)^Citation78	Retrospective	100	Quadra Q4	3–6	4	/	No	Decreased scoring of lid margin edema, lid margin telangiectasia, lid margin vascularity, meibum viscosity, OSDI score. Increased oil flow score and TBUT
Mejia et al (2019)^Citation73	Retrospective cross sectional	25	E>Eye	0-2-6	3	9,8–13	/	Improved symptoms, TBUT, Schirmer and VB scores
Toyos et al (2015)^Citation20	Retrospective noncomparative case series	91	Quadra Q4	4	7	8–20	Blistering, cheek swelling, conjunctival cyst, floaters, hair loss, light sensitivity, redness	Improved TBUT and dry eye symptoms.
Vegunta et al (2016)^Citation86	Retrospective	35	Quadra Q4	4–6	1–4	/	No	Decreased SPEED2 Increased meibomian gland expression (MGE)

Abbreviations: TBUT, tear break-up time; MGE, meibomian gland expressibility; VB van Bijsterveld.

Table 2 Prospective Clinical Trials For IPL Therapy In DED

Study (Year)	Design	Patients (n)	IPL Device	Frequency (Weeks)	IPL Sessions (n)	IPL Energy (J/cm^2)	Adverse Events	Results
Ahmed et al (2019)^Citation87	Prospective controlled	12	Philips Lumea	/	1	2,5–6,5	No	Improved tear protein and lipid content and composition
Albietz et al (2017)^Citation30	Prospective noncomparative	26	E>Eye	0-2-6	3	9,8–13	No	Improved DE symptoms, MG secretion quality, expressibility and ocular surface inflammation
Arita et al (2018)^Citation22	Prospective noncomparative	31	Lumenis	3	4–8	11–14	/	Improved SPEED, TBUT, CFS and MB parameters
Arita et al (2019)^Citation21	Prospective controlled randomized	45	Lumenis	3	8	11–14	No	Improved LLT, TBUT, lid margin abnormalities and MGS
Choi et al (2019)^Citation23	Prospective noncomparative	30	Lumenis	3	3	12–14	No	Improved MG function, tear stability and decreased inflammation (IL-4, IL-6, IL-10, IL-17A, TNF-α)
Dell et al (2017)^Citation24	Prospective interventional noncomparative	40	Lumenis	3	4	/	/	Increased TBUT Improved SPEED, MGS, CFS and TFO
Guilloto et al (2017)^Citation31	Prospective noncomparative	36	E>Eye	2	4	8–20	Redness and light sensitivity	Improved TBUT, Schirmer test and lacrimal meniscus
Jiang et al (2016)^Citation29	Prospective	40	E>Eye	0-2-6-10	4	9,8–13	No	Improved TBUT, conjunctival injection, symptoms and MG parameters.
Karaca et al (2018)^Citation85	Prospective noncomparative	26	E>Eye	0-2-6	3	/	No	Improved TBUT, Schirmer test, OSDI score and SPEED
Li et al (2019)^Citation25	Prospective comparative	40	Lumenis	0-2-6	3	14–16	Erythema, edema, blister, purpura, hyperpigmentation	Improved TBUT and OSDI score.
Seo et al (2018)^Citation26	Prospective noncomparative non-randomized	17	Lumenis	3	4	11	No	Long-term improvement of lower lid margin vascularity, meibum expressibility, quality and symptoms. Improved TBUT, CFS.
Vigo et al (2019)^Citation79	Prospective noncomparative	19	E>Eye	0-2-6	3	9–13	/	Increased TBUT and LLT
Yin et al (2017)^Citation27	Prospective comparative	35	Lumenis	4	3	16–17	No	Increased TBUT, meibum quality, MG expressibility and dropout. Improved MG microstructure and decreased inflammation

Abbreviations: DE, dry eye; MG, meibomian glands; TBUT, tear break-up time; SPEED, standard patient evaluation of eye dryness; MGS, meibomian gland score; CFS, corneal fluorescein staining; TFO, tear film osmolarity; LLG, improved lipid layer grade; LLT, lipid layer thickness; OSDI, ocular surface disease index; MGYSS, meibomian gland yielding secretion score.

Table 3 Randomized Clinical Trials For IPL Therapy In DED

Study (Year)	Design	Patients (n)	IPL Device	Frequency (Weeks)	IPL Sessions (n)	IPL Energy (J/cm^2)	Adverse Events	Results
Craig et al (2015)^Citation28	Prospective controlled	28	E>Eye	0-2-6 6	3	9–13	/	Improved LLG, TBUT and VAS symptom score
Liu et al (2017)^Citation69	Prospective controlled randomized double-masked	44	Lumenis	4	3	14–16	/	Decreased levels of inflammation markers (IL-17A, IL-6, PGE2)
Rong et al (2018)^Citation76	Prospective controlled randomized double-masked	44	Lumenis	4	3	14–16	Mild pain and burning, partial eyelash loss	Improved MGYSS, TBUT, SPEED, CFS.
Rong et al (2018)^Citation77	Prospective controlled randomized	28	Lumenis	4	3	14–16	No	Improved MG secretion function and TBUT by 6 months after IPL

Abbreviations: LLG, lipid layer grade; TBUT, tear break-up time; MGYSS, meibomian gland yielding secretion score; CFS, corneal fluorescein staining; SPEED, standard patient evaluation of eye dryness; MG, meibomian gland.

Table 4 Ongoing Clinical Trials For IPL Therapy In DED

Study	Design	Condition	Patients (n)	Control Arm	IPL Device	Number Of IPL Sessions	Frequency	Outcomes	Concomitant Therapy
Dell et al (2018)	Interventional Randomized Single-masked	MGD	50	Sham IPL + MGX	Lumenis	4	2	TBUT; OSDI; EDS; Eyelid appearance; meiboscore; incidence of adverse events; pain during procedure; biomicroscopy	MGX
Pyacomn et al (2018)	Interventional Randomized Double masked	MGD	114	Sham IPL	E>Eye	3	1-2-6	TBUT; OSDI; LLT; meiboscore; CFS; MGE; meibum quality; TFO (6 months follow-up) ST; IL-1Ra; IL-6	Warm compression, lid scrub, non preservative ocular lubricants
Wood et al (2017)	Interventional Randomized Double-masked	Evaporative DED	14	Sham IPL	/	4	/	TBUT (4 months follow up); OSDI (7 months follow up)	/
Shen et al (2017)	Interventional randomized open label	Ocular rosacea	20	MGX	/	4	4	OSDI (4 months follow-up); pathologic microbial load (4 months follow-up); TGF-B1 (4 months follow-up)	MGX, topical anesthetic for DED
Zadock et al (2017)	Interventional randomized single-masked	MGD	24	Sham IPL + MGX	Lumenis	4	2	TBUT (10 weeks follow-up); MG secretion score; OSDI; MGYLS; TFO; meiboscore; eyelid appearance (10 weeks follow-up)	MGX
Dell et al (2015)	Interventional noncomparative	MGD	44	/	Lumenis	4	/	TBUT (3 weeks after each IPL session); CFS; MGS; SPEED; TFO; LLT; incidence of adverse events; immediate/short term skin response; subjective level of pain/discomfort	MGX

Abbreviations: TBUT, tear break-up time; OSDI, ocular surface disease index; EDS, eye dryness score; LLT, lipid layer thickness; CFS, corneal fluorescein staining; MGE, meibomian gland expressibility; TFO, tear film osmolarity; MGLYS, meibomian glands yielding liquid secretion; SPEED, standard patient evaluation of eye dryness.

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