RF combined with IPL and gland expression was associated with better meibum quality and dry-eye symptoms in -related dry eye.
Evidence
An interventional treatment series of 31 subjects measured , , NIBUT, meibography, and MMP-9 before and after four RF+IPL+MGX treatments, with an adjusted historical IPL+MGX comparison.
Caveat
The RF contribution remains uncertain because the comparator was historical rather than randomized, OSDI improvement was not significantly greater, and NIBUT did not change.
Simplified
PURPOSE: To evaluate the efficacy of multi-frequency RF and IPL + MGX combination for treatment of (MGD).
PATIENTS AND METHODS: Eligible subjects had signs and moderate-to-severe symptoms of DED (Dry Eye Disease) due to MGD. Subjects underwent 4 treatments at 2-week intervals. Each treatment consisted of intense pulsed light (IPL) followed by radiofrequency (RF) on the periocular skin, followed by meibomian gland expression (MGX). The main outcome measure was the quality of meibum in 15 meibomian glands along the lower eyelid, using the (mMGS). The main hypothesis was a reduction of mMGS between the baseline (BL) and the follow-up (FU). Other outcome measures, such as symptoms measured with the (Ocular Surface Disease Index) questionnaire, meibography, non-invasive tear break-up time (NIBUT), and matrix metallopeptidase 9 (MMP-9) levels in tear samples were evaluated as well.
RESULTS: 31 subjects completed the FU. Between BL and FU, mMGS decreased from 30.4 (8.5) to 9.3 (9.5) (-69.3%, 95% CI: -55.6% to -82.9%, p<0.0001); OSDI decreased from 63.6 (17.2) to 25.0 (20.6) (-60.7%, 95% CI: -47.8% to -73.5%, p<0.0001); NIBUT did not change (p=0.92). An adjusted model with a historical control was constructed to allow the comparison of these subjects with those treated similarly with IPL+MGX (but without RF) in a different study. This analysis identified that the change in mMGS was larger when RF was included (-20.9 vs -18.3, adjusted p-value (p_adjusted) <0.05). The difference in OSDI change was not significant (-38.1 vs -25.5, p_adjusted = 0.196).
CONCLUSION: Combination of multi-frequency RF and IPL+MGX improves signs and symptoms of MGD. In comparison to a historical control, improvements were generally larger. A randomized controlled study comparing the combination of RF and IPL+MGX with IPL+MGX alone is required to further elaborate the relative contribution of RF.
Key numbers
21.0
Decrease in
decreased from 30.4 to 9.3.
38.6
Decrease in
scores dropped from 63.6 to 25.0.
3.8 sec
Increase in NIBUT
NIBUT increased by 3.8 seconds in a subgroup.
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